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RealIDPlease indicate your position choice:Entry DatePlease indicate the date you can begin training:FirstLastEmailPersonal detailsSkype Contact Details:Street AddressAddress Line 2CityZIP / Postal CodeBest Contact Tel number:Date of birth:Place of birth:Age:GenderMarital status:Height:Weight:Nearest Airport:UK Nat Ins No:Passport detailsPassport Number:Country of Issue:Date of Issue:Expiry Date:Next of Kin DetailsNext of Kin:Relationship:Next of Kin Tel:Street AddressAddress Line 2CityZIP / Postal CodeWhere 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 trueName of the School/College/University most recently attended (one only):Street AddressAddress Line 2CityZIP / Postal CodeTel 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 qualificationsCourse Name:Level:Year of Examination:Actual Grade Achieved:Predicted Grade (if not completed):Additional qualificationsCourse Name:Level:Year of Examination:Actual Grade Achieved:Predicted Grade (if not completed):Additional qualificationsCourse Name:Level:Year of Examination:Actual Grade Achieved:Predicted Grade (if not completed):Hobbies / InterestsPlease 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 InterestPrevious Merchant Navy ExperienceHave 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 detailsName of Company or Organisation:Position held:Start date:End date:Reason for leaving:Company detailsName of Company or Organisation:Position held:Start date:End date:Reason for leaving:Notice period required:ReferencesFirst CompanyCompany/College/School name:Name of Referee:Street AddressAddress Line 2CityZIP / Postal CodeCompany Tel:Position/Relationship:Company Email:Company/College/School name:Name of Referee:Street AddressAddress Line 2CityZIP / Postal CodeCompany Tel:Position/Relationship:Company Email:Declaration:Please tick this box to confirm your understanding and agreement of this statement:ProgressNext of Kin EmailDo you have any ongoing/previous medical conditions not listed above, for which you have had treatment via the NHS or a private company?:
RealIDPlease indicate your position choice:Entry DatePlease indicate the date you can begin training:FirstLastEmailPersonal detailsSkype Contact Details:Street AddressAddress Line 2CityZIP / Postal CodeBest Contact Tel number:Date of birth:Place of birth:Age:GenderMarital status:Height:Weight:Nearest Airport:UK Nat Ins No:Passport detailsPassport Number:Country of Issue:Date of Issue:Expiry Date:Next of Kin DetailsNext of Kin:Relationship:Next of Kin Tel:Street AddressAddress Line 2CityZIP / Postal CodeWhere 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 trueName of the School/College/University most recently attended (one only):Street AddressAddress Line 2CityZIP / Postal CodeTel 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 qualificationsCourse Name:Level:Year of Examination:Actual Grade Achieved:Predicted Grade (if not completed):Additional qualificationsCourse Name:Level:Year of Examination:Actual Grade Achieved:Predicted Grade (if not completed):Additional qualificationsCourse Name:Level:Year of Examination:Actual Grade Achieved:Predicted Grade (if not completed):Hobbies / InterestsPlease 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 InterestPrevious Merchant Navy ExperienceHave 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 detailsName of Company or Organisation:Position held:Start date:End date:Reason for leaving:Company detailsName of Company or Organisation:Position held:Start date:End date:Reason for leaving:Notice period required:ReferencesFirst CompanyCompany/College/School name:Name of Referee:Street AddressAddress Line 2CityZIP / Postal CodeCompany Tel:Position/Relationship:Company Email:Company/College/School name:Name of Referee:Street AddressAddress Line 2CityZIP / Postal CodeCompany Tel:Position/Relationship:Company Email:Declaration:Please tick this box to confirm your understanding and agreement of this statement:ProgressNext of Kin EmailDo you have any ongoing/previous medical conditions not listed above, for which you have had treatment via the NHS or a private company?: