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Application Form-GPSMS

APPLICATION FORM-GPSMS

Application for GP Rating/Deck Cadet/Engine Cadet:	*
Course Code:

DD No :		Issuing Bank:
Ref. ID.

A) PERSONAL PARTICULARS:

Name (in full):	*
Address:
Postcode
Town / City:
State*:
Telephone (Home)*:
Mobile Phone:


Date of Birth (dd/mm/yyyy):		*

Citizenship:

Place of Birth:

Religion:

Email Address:	*

Gender:

Age:	*
Weight (kg):
Passport

B) ACADEMIC QUALIFICATION FOR GP RATING/DECK CADET /ENGINE CADET:

School Exam Result - 10+2
Year:

Subject

Grades Obtained / % Of Marks

English Language

Mathematics

Physics

Chemistry

School Exam Result - 10+2
Year:

Subject

Grades Obtained / % Of Marks

English Language

Mathematics

Physics / Science

Academic Qualification for engineering Candidate TME Programe (B.Tech. Mech/EEE/Automobile)

Qualification B.Tech. Mech

EEE

Automobile

Year

% Of Marks

C) QUESTIONS:

1) Are you a swimmer?

Answer:

2) Are you wearing visual aids (spectacles or contact lens)?

Answer:

If "Yes", please advise the degree of your visual aid :

3) Are you colour blind?

Answer:

4) Are you suffering from any illness that may hinder you from attending any course?

Answer:

5) Extra Curricula Acitivities:

1
2
3
4

5.3) Sports
Representing

6) Hobbies:

Answer:

D) PARENTS / GUARDIAN INFORMATION:

Father / Guardian's Name	*

Occupation:	*

Telephone (Home):	*
Mobile Phone:	*

E)EMERGENCY CONTACT DETAILS FOR NEXT OF KIN

Name:

Address:

Telephone (Home):
Mobile Phone:

Relationship:

F) INSTRUCTIONS TO APPLICANTS

1) This form must be completed and submitted via email to (info@merchantnavy.co) and a printed copy is to be brought along on the interview day (if you are successful) together with certified photocopies of the following documents:-

G) DECLARATION

Signature

I confirm and certify that the information given above are true.

		Instruction
	To All Candidates:
	1. Candidates need to fill their application form carefully. 2. Course selection should be as per the eligibility criteria mentioned in website. 3. Candidates need to courier the hardcopy of application form along with DD of Rs.500 which is supposed to be taken in favour of “Global Pacific Shipping and Marine Services, payable at New Delhi “. 4. After receiving application form candidates will be informed for Written Test /Interview in due course by way of e-mail/courier/phone. 5. At the time of examination candidates need to carry all the relevant documents (10th, 12th / B.Tech). 6. After examination, shortlisted candidate will be notified by e-mail/phone/courier.

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