1. Employment Application Form
POST APPLIED FOR MASTER ARE YOU WILLING TO JOIN A
RANK LOWER IF CURRENT
POSITION IS NOT AVAILABLE
N
DATE AVAILABLE
FROM
NOW HEIGHT – 181 CM
EYE SIGHT - 6/6 WEIGHT – 80 kg
PERSONAL DETAILS
SURNAME
ALAM
FIRST NAME
GOLAM AHMED
MIDDLE NAME
KHAIRUL
NATIONALITY:
BANGLADESHI
DATE OF BIRTH
09/06/1958
PLACE OF BIRTH; DHAKA
PRESENT ADDRESS
ROAD NO 113,HOUSE NO 3/A
GULSHAN, DHAKA
BANGLADESH
PERMANENT ADDRESS
PRESENT ADDRESS
ROAD NO 113,HOUSE NO 3/A
GULSHAN, DHAKA
BANGLADESH
Tel No : 01817519618 Tel No :
Mobile No: 01742701554 Mobile No: 01742701554
Email : khairulalam73@yahoo.com Email : khairulalam1958@yahoo.com,
khairulalam855@yahoo.com
IDENTITY DOCUMENTS
DOCUMENT PLACE OF ISSUE NUMBER DATE OF ISSUE DATE OF EXPIRY
PASSPORT: DHAKA BJ0698756 28/12/2015 27/12/2020
OTHER VALID
VISA: USA
DHAKA 20062534020035 12/02/2012 12/02/2017
SEAMAN BOOK CHITTAGONG C/0/0604 03/04/2006 03/04/2021
FLAG STATE
SINGAPORE VALID
YELLOW FEVER YES ENSURE AT LEAST 2 BLANK PAGES IN YOUR
PASSPORT : YES
DATE OF ISSUE:
02/09/2010 CLOSEST AIRPORT: Dhaka International Air Port
DATE OF EXPIRY:02/09/2020
US VISA: VALID TIL 12/*02/2017 20062534020035
DATE OF ISSUE:12/02/2012 DATE OF EXPIRY:12/02/2017

2. License and CertificationInformation
Certificates Grade Number Issued Validity Issued at
Certificate of Competency / Watchkeeping
MASTER
UNLIMITED CoC0011885 19/05/2001
16th of
October 2020 MCA/UK
Endorsement to Certificate of Competency
GMDSS (GOC) SING H 0536 17/11/2014 16/11/2019
iDA SINGAPORE.
Appliedfor
revalidation.
GMDSS (Endorsement) NA NA NA NA
STCW Certification Grade Number Issued Validity Issued at
Personal Survival Techniques
Proficiency in Survival Craft and Rescue
Boats/ PSC-RB PSCRB 1107/04 30.11.2011 30.11.2016
Maritime Institute of
Science & Technolog
Personal Safety and Social Responsibilities PSSR 1107/07 13.12.2011 12.12.2016
Maritime Institute of
Science & Technolog
Elementary First Aid FASC 24.05.1983 NA
GOVT.MARINE
ACADEMY CH
Medical first Aid / Master's Medicare 99100 18.12.2011 18.12.2016
International Institut
of Maritime
Technology
Fire Preventionand Fire Fighting
Advanced Fire Fighting FFC2133 29.06.2012 28.12.2016
GOVT.MARINE
ACADEMY CHT
Tanker Familiarization(Oil)
Tanker Familiarization(Chemical)
Tanker Familiarization(Gas)
Advanced Tanker Safety(TASCO) - Petroleum
Advanced Tanker Safety(CHEMCO)-
Chemical
Advanced Tanker Safety(GASCO)-Gas
Radar Observer 14/0239 08.06.1984 NA
S .TYNE S
COLLEGE. UNITED
KINGDOM
Radar Simulator
Automatic Radar Plotting Aids 14/00672 26.02.1988 NA
S .TYNE S
COLLEGE. UNITED
KINGDOM
Yellow Fever 02.09.2010 01.09.2020 DHAKA
ECDIS ECDIS 23.04.2015
28/05/20
09
UMA
MCA
aproved
Other Certification Grade Number Issued Validity Issued at
Ship Security Officer SSO/1305/05 26.02.2013 26.02.2018
International Institut
of Maritime
Technology
Liquid Cargo Handling Simulator
Bridge Team Management (BTRM/ BRM) SIN-02-0044 12.09.2003 NA
SINGAPORE
POLYTECHNIC
Bridge Simulator 0088 20.02.2001 NA PSA SINGAPORE
Engine Room Simulator
Inert Gas Systems
Hazmat Course BMTI/01032669 29.08.2007 NA BMTI
Fast Rescue Boat (FRB) PSC 1371 24.05.2012 23.05.2017
GOVT.MARINE
ACADEMY CH
Ship Safety Officer Course
RevalidationCOURSE
Ref & Updating Trg

3. COMPANY VESSEL NAME VESSEL TYPE D.W.T ./
GRT
VSL AGE TYPE OF
ENGINES –
MANDATE
RANK SIGN ON
DATE
SIGN OFF
DATE
DURATION
Y/M/D
REASONS FOR
S/OFF
UNITED OCEAN SHI
MANAGEMENT.
SINGAORE
M V UNITED
SERENITY
BULK
CARRIER
82000 6 YEARS MAN MASTER 24/04/2015 28/08/2015 4M 03 D CMLETION
OF
CONTRACTWALLEM SHIP
MANAGEMENT.HK
CEDAR 6
BULK
CARRIER
79224
MT
3.5
YEARS
MAN/B&W MASTER 25/05/2014 27/09/2014 4 M 02 DA COMPLETIO
N OF
CCCCONTRA
CTCONTRAC
T
WALLEM SHIP
MANAGEMENT.HK
PINE 2
MULTIPURP
OSE VESSEL
34000 3 YEARS MAN MASTER 19/05/2013 14/10/2013 5 M OO D END OF
CONTRACT
ACCORD MARINE
MANAGEMENT PVT
LTD
M V AASHMAN
LOG
CARRIER
25000/
15045
MT
28 YEARS MAN MASTER
17/02/2012 13/07/2012
4 M 27D END OF
CONTRACT
SIMATECH
SHIPPING LLC
SIMA SAMAN
CONTAINER
1500 TEUS
18000 MT
4 YEARS MAN/B&W MASTER
19/05/2011 25/08/2011 03M 06D
END OF
CONTRACT
SIMATECH
SHIPPING LLC
SIMA PAYA
CONTAINER
1300 TEUS
17500 MT 4 YEARS MAN/B&W MASTER
25.09.2010 04.02.2011 04M 08D
END OF
CONTRACT
MANSHIP
PTE/SINGAPORE
QC VISION
Container
991 TEUS
9957 GRT
MT
1 YEARS MAN MASTER
24/11/2009 16/05/2010
04M 22D
END OF
CONTRACT
MANSHIP
PTE/SINGAPORE
M V GENIUS
Container
991 TEUS
9954 GRT
MT
1 YEARS MAN MASTER 24/11/2008 28/05/09
06M 04D
END OF
CONTRACT
AL UNITED
MARITIME
EASTERN SEA
MULTIPURPOS
E /LOG
CARRIER
800 TEUS
10018
GRT
20 YEARS SULZER
MASTER
06/12/2007 24/06/2008
06M 00D
END OF
CONTRACT
MAERSK LINE
SEALAND
INTEGRITY
CONTAINER
4614 TEUS
57075
GRT
22 YEARS
MAN
CHIEF
OFFICER
26/03/2007 26/06/2007 03M 00 D
END OF
CONTRACT
MAERSK LINE SEALAND
INTEGRITY
CONTAINER
4614 TEUS
57075
GRT
22 YEARS4
MAN
CHIEF
OFFICER
04/06/2006 27/08/2006 02M 24D
END OF
CONTRACT
MAERSK LINE MAERSK WIND RO RO/PCTC
5200 UNITS
51770
GRT 4 YEARS
KAWASAKI
CHIEF
OFFICER
27/05/2004 09/10/2004 04 M 15 D END OF
CONTRACT
MAERSK LINE
MAERSK
ANTWERP
CONTAINER
992 TEUS
14063
GRT
KAWASAKI CHIEF
OFFICER
13/10/2003 03/02/2004
03M 20D
END OF
CONTRACT
MAERSK LINE
SEALAND
INTREPID
CONTAINER
4060 TEUS
49985
GRT 5 YEARS
KAWASAKI
CHIEF
OFFICER
R
28/03/2003
01/08/2003 04M 03D
END OF
CONTRACT
MAERSK LINE
MAERSK
ATLANTIC
CONTAINER
992 teus
14063
GRT 4 YEARS
KAWASAKI
CHIEF
OFFICER 20/08/2002 21/12/2002 04 M 03 D
END OF
CONTRACT

4. Ocean
Tramping.HK
SEA DANIEL
BULK
CARRIER
36000
DWT
12
YEARS DOXFORD
CHIEF
OFFICER
05/09/90 27/04/91
07M 22D
END OF CON
Ocean
Tramping
APT MARINER
BULK
CARRIER
44000
DWT
15 YEARS
MAN CHIEF
OFFICER
05/08/91 12/02/92
06M 07D
END OF CON

5.  Sea time calculations mentioned above Mandate for all TOP FOUR officersbeing proposed, without
which CV will be not considered.
 Ref Checks a MUST, please fill in the details.
MISCELLANEOUS – Please provide below details for further assessment
A} DECK OFFICERS
Sea Time in Rank – e.g 12 m 15 days
Sea Time on Type vsls
Overall Tanker Exp
MASTER = 29 M 07 DAYS/cont & bulk
C/O = 41 M 28 DAYS cont & bulk/g
Cargo
Chemical: Type of Cargo Carried
NA
Tanker: Type of Pumps
NA
Vetting:
NA
B} ENGINEERS
Sea Time in Rank – e.g 12 m 15 days
Sea Time on Type vsls
Overall Tanker Exp
Automation: {Type}
Vetting:
C}ELECTRICAL OFFICERS
Automation:{Type}
EXP on Inert Gas System
PLC {NAME}
D} GENERAL TRADING AREA OF
VESSEL
E} OIL MAJOR INSPECTIONS
F}DRY DOCKING EXPERIENCE
G}PRE-SEA TRAINING
{Period/Institution}
H} SCHOLASTIC EDUCATION
References (Please give the name and address of your current or immediate past
employer)
S. NO NAME ADDRESS TELEPHONE NO
1. SURJIT KUMAR
/SUPNTNDDEYDEY
ACCORD MARINE
AMANGNTMUMBAI
91 9167832815
Officer Approved by : Officer Approved by Technical Team
Signature : Signature :
Date : Date :