Application Form

Alternatively you may download the application form as a PDF document and fill it in offline. When applying, if possible, please send copies of your seagoing certification for our files.

* denotes a required field

CONTACT DETAILS (Please enter details)
Rank:	*	Place of Birth:
Department:		Date of Birth:	*
Title:	Mr Mrs Miss Ms Dr *	Nationality:	*
First Names:	*	Telephone Number 1:	*
Surname:	*	Telephone Number 2:
Postal Address:	*	Fax. Number:
		Email Address:	*
		Nearest station/airport:
Country:	Please select a country... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Hercegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkino Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Channel Islands - Guernsey Channel Islands - Jersey Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guyana French Metropolitaine French Polynesia French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary INTERNATIONAL Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Democratic People's Republic Of Korea Kuwait Kyrgystan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Soloman Islands Somalia South Africa South Georgia/South Sandwich Islands Soviet Union Spain Sri Lanka St Helena St Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Minor Outlying Islands US Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uraguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (British) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe	Height:
Postcode:		Weight:

CERTIFICATE OF COMPETENCY (latest only)
DETAILS	ISSUE DATE	EXPIRY DATE	COUNTRY OF ISSUE	LIMITATIONS, CERT NOS.

ENDORSEMENTS (Check those that apply)
DCE Petroleum Endorsements1	DCE Chemicals Endorsements2	DCE Gas Endorsements3

CERTIFICATE CHECKLIST
DETAILS	ISSUE DATE	EXPIRY DATE	LIMITATIONS, CERT NOS.
Discharge book/Seaman's book
Passport
ENG1 / Medical cert
US Visa
UK Work Permit
Visas

SHIP EXPERIENCE (Check those that apply and indicate number of years experienced on those vessels)
CARGO EXP. (Check) NO. OF YEARS  Bulk  Car Carrier  Container Vessel  General Cargo  Reefer  OBO  Livestock  OFFSHORE EXP. (Check) NO. OF YEARS  AHTS  Supply  Standby  Survey  Drill / Rig  Dive Support  Cable Layer  Tug  FPSO		TANKERS EXP. (Check) NO. OF YEARS  Chemical  Product  LNG  LPG  VLCC  PASSENGER EXP. (Check) NO. OF YEARS  Cruise  Fast Ferry  Freight Ro-Ro  Passenger Ro-Ro  GENERAL EXP. (Check) NO. OF YEARS  Research  Dredger  Fishing Vessel  RFA  Royal Navy

TYPE OF EMPLOYMENT SOUGHT
I am seeking  please select... permanent employment temporary employment
Maximum tour of duty:		Position sought:
Trading area:		Vessel types:

AVAILABILITY (enter details)

SUPPLEMENTARY CERTIFICATE CHECKLIST
STCW 95 SUPPLEMENTARY CERTIFICATES	ISSUE DATE	EXPIRY DATE	LIMITATIONS, CERT NOS.
Personal Survival Techniques (PST)
Fire Prevention & Fire Fighting
Elementary First Aid
Personal Safety and Social Responsibility
Advanced Fire Fighting
Medical Care
Medical First Aid
Proficiency in survival craft & rescue boats
Fast Rescue Craft
Engine Room Watch Rating Cert
Navigational Watch Rating Cert

OTHER SUPPLEMENTARY CERTIFICATES
Offshore Survival
GMDSS (GOC/ROC)
DPO
Other(s)

WORK HISTORY (Please list commencing with present/most recent employment)
COMPANY	RANK	DATE FROM	DATE TO
*	*	*	*

LANGUAGES (Select either basic or fluent)
ENGLISH	please select... basic fluent
OTHER (please specify)	please select... basic fluent

REFEREES - previous employers
Name:		Name:
Address:		Address:
Postcode:		Postcode:
Tel No.:		Tel No.:
Fax No.:		Fax No.:
Please indicate if NuWave Personnel can take up references please select... now later

I can confirm that the details given within this application form are, to the best of my knowledge, accurate and true, and that I am legally in possession of the afore mentioned qualifications and certificates.
Full Name:	*	Today's Date:	*

If you would like to also attach your C.V. you can do so. Please ensure that the C.V. is in Microsoft Word, Adobe PDF, RTF or Plain Text format.
Attach C.V.

Our application form is also available to download as an Adobe Acrobat document. Once it has downloaded, print it out, complete it and send it to:

Nuwave Personnel Ltd
Cams Hall, Cams Hill
Fareham, Hampshire
England
PO16 8AB

If you have any questions please email us at info@nuwavepersonnel.com or contact us by phone or post.