CMT Application Form – CSVclydetraining2019-06-20T15:57:00+01:00
RealID
Please indicate your position choice:
Entry Date
Please indicate the date you can begin training:
First
Last
Email
Personal details
Skype Contact Details:
Street Address
Address Line 2
City
ZIP / Postal Code
Best Contact Tel number:
Date of birth:
Place of birth:
Age:
Gender
Marital status:
Height:
Weight:
Nearest Airport:
UK Nat Ins No:
Passport details
Passport Number:
Country of Issue:
Date of Issue:
Expiry Date:
Next of Kin Details
Next of Kin:
Relationship:
Next of Kin Tel:
Street Address
Address Line 2
City
ZIP / Postal Code
Where did you first hear about Clyde Marine Training?:
Please tick the nearest interview location:
I can confirm that I hold - or are eligible to hold - a valid EU Passport and have been permanently resident within the UK for the last 36 months:
Yes – I can confirm the above is true
Name of the School/College/University most recently attended (one only):
Street Address
Address Line 2
City
ZIP / Postal Code
Tel No. of Educational Est. named above:
Dates from:
Dates to:
Academic Qualifications (Please supply all academic results)
Level (i.e. GCSE):
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Level (i.e. GCSE):
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Level (i.e. GCSE):
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Level (i.e. GCSE):
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Level (i.e. GCSE):
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Level (i.e. GCSE):
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Other subjects: Please list all GSCEs / Standard Grades, Intermediate 1s, Intermediates 2, AS levels and A levels not indicated above:
Additional qualifications
Course Name:
Level:
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Additional qualifications
Course Name:
Level:
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Additional qualifications
Course Name:
Level:
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Hobbies / Interests
Please list any sports or other interests you have and any clubs or societies you are currently involved in or have been a member of:
Have you ever been arrested, cautioned or convicted for any offence or crime (including any motoring convictions or offences) or have any proceedings pending?:
Would you have any objection to us conducting a criminal record check?:
If you have answered yes to any of the above please give additional information below:
Career Interest
Previous Merchant Navy Experience
Have you ever been offered a place on or commenced on a Merchant Navy training programme at any level?:
Have you ever applied for or held a Discharge Book?:
If you have answered YES to any of the above please give additional information below:
Do you suffer from any of the following conditions - hearing/visual impairment (including use of glasses/contact lenses or colour blindness), serious illness, diabetes, asthma, allergies, or had operations in the last five years?:
Do you suffer from any form of diabetes?:
Have you ever suffered from any serious illness?:
Have you ever suffered from asthma?:
Have you ever suffered from blackouts or epilepsy?:
Have you had any operations in the last 5 years?:
Have you ever suffered or currently suffer from any allergies?:
Are you currently taking any form of prescribed medication?:
If you have answered YES to any of the above please list details below:
Name of Company or Organisation:
Position held:
Start date:
End date:
Reason for leaving:
Company details
Name of Company or Organisation:
Position held:
Start date:
End date:
Reason for leaving:
Company details
Name of Company or Organisation:
Position held:
Start date:
End date:
Reason for leaving:
Notice period required:
References
First Company
Company/College/School name:
Name of Referee:
Street Address
Address Line 2
City
ZIP / Postal Code
Company Tel:
Position/Relationship:
Company Email:
Company/College/School name:
Name of Referee:
Street Address
Address Line 2
City
ZIP / Postal Code
Company Tel:
Position/Relationship:
Company Email:
Declaration:
Please tick this box to confirm your understanding and agreement of this statement:
Progress
Next of Kin Email
Do you have any ongoing/previous medical conditions not listed above, for which you have had treatment via the NHS or a private company?:
RealID
Please indicate your position choice:
Entry Date
Please indicate the date you can begin training:
First
Last
Email
Personal details
Skype Contact Details:
Street Address
Address Line 2
City
ZIP / Postal Code
Best Contact Tel number:
Date of birth:
Place of birth:
Age:
Gender
Marital status:
Height:
Weight:
Nearest Airport:
UK Nat Ins No:
Passport details
Passport Number:
Country of Issue:
Date of Issue:
Expiry Date:
Next of Kin Details
Next of Kin:
Relationship:
Next of Kin Tel:
Street Address
Address Line 2
City
ZIP / Postal Code
Where did you first hear about Clyde Marine Training?:
Please tick the nearest interview location:
I can confirm that I hold - or are eligible to hold - a valid EU Passport and have been permanently resident within the UK for the last 36 months:
Yes – I can confirm the above is true
Name of the School/College/University most recently attended (one only):
Street Address
Address Line 2
City
ZIP / Postal Code
Tel No. of Educational Est. named above:
Dates from:
Dates to:
Academic Qualifications (Please supply all academic results)
Level (i.e. GCSE):
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Level (i.e. GCSE):
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Level (i.e. GCSE):
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Level (i.e. GCSE):
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Level (i.e. GCSE):
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Level (i.e. GCSE):
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Other subjects: Please list all GSCEs / Standard Grades, Intermediate 1s, Intermediates 2, AS levels and A levels not indicated above:
Additional qualifications
Course Name:
Level:
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Additional qualifications
Course Name:
Level:
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Additional qualifications
Course Name:
Level:
Year of Examination:
Actual Grade Achieved:
Predicted Grade (if not completed):
Hobbies / Interests
Please list any sports or other interests you have and any clubs or societies you are currently involved in or have been a member of:
Have you ever been arrested, cautioned or convicted for any offence or crime (including any motoring convictions or offences) or have any proceedings pending?:
Would you have any objection to us conducting a criminal record check?:
If you have answered yes to any of the above please give additional information below:
Career Interest
Previous Merchant Navy Experience
Have you ever been offered a place on or commenced on a Merchant Navy training programme at any level?:
Have you ever applied for or held a Discharge Book?:
If you have answered YES to any of the above please give additional information below:
Do you suffer from any of the following conditions - hearing/visual impairment (including use of glasses/contact lenses or colour blindness), serious illness, diabetes, asthma, allergies, or had operations in the last five years?:
Do you suffer from any form of diabetes?:
Have you ever suffered from any serious illness?:
Have you ever suffered from asthma?:
Have you ever suffered from blackouts or epilepsy?:
Have you had any operations in the last 5 years?:
Have you ever suffered or currently suffer from any allergies?:
Are you currently taking any form of prescribed medication?:
If you have answered YES to any of the above please list details below:
Name of Company or Organisation:
Position held:
Start date:
End date:
Reason for leaving:
Company details
Name of Company or Organisation:
Position held:
Start date:
End date:
Reason for leaving:
Company details
Name of Company or Organisation:
Position held:
Start date:
End date:
Reason for leaving:
Notice period required:
References
First Company
Company/College/School name:
Name of Referee:
Street Address
Address Line 2
City
ZIP / Postal Code
Company Tel:
Position/Relationship:
Company Email:
Company/College/School name:
Name of Referee:
Street Address
Address Line 2
City
ZIP / Postal Code
Company Tel:
Position/Relationship:
Company Email:
Declaration:
Please tick this box to confirm your understanding and agreement of this statement:
Progress
Next of Kin Email
Do you have any ongoing/previous medical conditions not listed above, for which you have had treatment via the NHS or a private company?:
