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Registration Form
Your Name
(required)
Address
Zip/Area Code
City
State/Province
Country
Phone #
Mobile #
Email
(valid email required)
Nationality
Date of Birth
Height ( cm )
Weight ( kg )
Other contact information
US Visa
C1/D
B1/B2
Tattoos visible in a uniform (where)
Do you smoke?
Yes
No
Do you drink?
Yes
No
Agree to security check:
Yes
No
Ever arrested/convicted
No
If yes, please stated the reason
Health status (in all):
Describe yourself as a person:
Hobbies:
Languages fluently:
Languages communicated
Computer skills:
Yes
No
CERTIFICATES
STCW-95 Certified
Yes
No
Date Issued
Type of licenses
AEC
MEOL
Y1
Y2
Y3
Y4
III/1
III/2
III/3
Date Issued
Other relevant training
US Visa
C1/D
B1/B2
OTHERS
Willing to share cabin with other crew
Yes
No
Willing to interact with guests (if no explain)
Willing to assist/perform tende operation for guest situations (if no explain)
SKILLS
(Rate from 1=novice to 5=expert)
Electronic
0
1
2
3
4
5
Electrical
0
1
2
3
4
5
Plumbing
0
1
2
3
4
5
Welding
0
1
2
3
4
5
SYSTEMS
(Rate from 1=novice to 5=expert)
Hydro fore Systems
0
1
2
3
4
5
Air Conditioning
0
1
2
3
4
5
Pneumatics Systems
0
1
2
3
4
5
Refrigeration
0
1
2
3
4
5
Water makers
0
1
2
3
4
5
Autopilot
0
1
2
3
4
5
Stabilizers
0
1
2
3
4
5
Bow Thrusters
0
1
2
3
4
5
Steering gear
0
1
2
3
4
5
Engine electronic Control System
0
1
2
3
4
5
Vessel Alarms
0
1
2
3
4
5
Monitoring Systems
0
1
2
3
4
5
Program Logic Controllers
0
1
2
3
4
5
Hydraulics
0
1
2
3
4
5
Navigation Bridge Electronics
0
1
2
3
4
5
Outboards
0
1
2
3
4
5
Jet skis/Wave runner
0
1
2
3
4
5
Mooring Equipment
0
1
2
3
4
5
EXPERIENCE
(Rate from 1=novice to 5=expert)
Diesel 2 Strokes
0
1
2
3
4
5
Diesel 4 Strokes
0
1
2
3
4
5
Diesel Turbo
0
1
2
3
4
5
Jet Engines/Gas Turbins
0
1
2
3
4
5
Gasoline 4-8 cylinders
0
1
2
3
4
5
Alternators DC
0
1
2
3
4
5
Generators
0
1
2
3
4
5
TROUBLESHOOTING
(Rate from 1=novice to 5=expert)
Diesel 2 Strokes
0
1
2
3
4
5
Diesel 4 Strokes
0
1
2
3
4
5
Diesel Turbo
0
1
2
3
4
5
Jet Engines/Gas Turbines
0
1
2
3
4
5
Gasoline 4-8 cylinders
0
1
2
3
4
5
Alternators DC
0
1
2
3
4
5
Generators
0
1
2
3
4
5
cforms
contact form by delicious:days
Christian’s story
Miguel’s story
An Introduction to T. Y. S.
