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Gebruiker Development
Application form
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Name
*
Dhr.
Dr.
Miss
Ms.
Mw.
Prof.
Rev.
Initials
Name
Last name
Address
*
Street name
City
Postal code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
E-mail
*
Phone number
*
Citizen service number
*
Nationality
*
Date of birth
MM slash DD slash YYYY
Place of birth
*
Gender
*
Marital status
*
Function
*
Available from
*
Net salary indication (current or last earned salary)
*
What qualifications do you have?
*
Service booklet
ADN Basic
ADN Chemistry
ADN Gas
Large Vessel Licence A
Barge licence
VHF radio
Radar
Skipper's certificate AB
Diploma of sailor
Other:
Namely:
What patents do you have?
*
No patent
Rhine patent to Rheinberg 857.4 - 806
Rhine patent to Neuss 806 - 740
Rhine patent to Niederkassel 740 - 666
Rhine patent to Ober Kahnstein 666 - 585
Rhine patent to Mainz 585 - 493
Rhine patent to Mannheim 493 - 412
Rhine patent to Iffezheim 412 - 334
Rhine patent tot Basel 334 - 164
Donau Patent
Elbe patent
Waal patent
How many years of inland navigation experience do you have?
*
Less than 1 year
1-2 year
2-5 year
5-10 year
Over 10 years
What languages do you speak?
*
Dutch
German
English
Polish
Czech
Romanian
Slovak
French
Bulgarian
Latvian
Which ships do you have experience with?
*
Dry cargo vessel
Container ship
Tanker Normal
Tanker Chemical
Tanker Gas
Stainless steel Tanker
Push boat
Tug
Passenger ship
Ro-Ro Ship
Tying
Which ships do you prefer to work on?
*
Dry cargo vessel
Container ship
Tanker Normal
Tanker Chemical
Tanker Gas
Stainless steel Tanker
Push boat
Tug
Passenger ship
Ro-Ro Ship
Tying
Which cruising system do you prefer?
*
Monday to Friday
7/7
14/14
21/21
30/30
Other sailing system
Namely:
Which driving licence do you have?
*
Licence A
Licence AM
Licence B
Licence BE
Licence C
Licence CE
None
What means of transport do you have?
*
Car
Engine
Public transport
None
Are you self-employed?
*
Yes
No
Are you open to extra work and/or temporary work?
*
Yes, for both options
For extra work
For temporary work
What is your current notice period?
*
1 month
2 months
None
List the last 5 ships you sailed on (type and ship name)
Current ship (if applicable)
Ship 1
Ship 2
Ship 3
Ship 4
Ship 5
Motivation
*
File
Max. file size: 900 KB.
Service booklet pages 1 to 12
Max. file size: 900 KB.
Skills document
Max. file size: 900 KB.
Skills document
Max. file size: 900 KB.
Copy ID/passport front and back
Max. file size: 900 KB.
Problems uploading PDF files? Then send it to admin@leviano-crewing.eu or by WhatsApp +31(0)6-51697548
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