Crew APPLICATION

Please list your journey leg/s in order of preference:

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Please list your sailing experience. ___________________________________________________________________________________________________________________

Have you received any formal instruction in sailing or navigation? If yes, please describe.

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Do you have a radio licence?_________________________________________

What experience do you have that could prove useful aboard? (Circle as appropriate) Watchstanding – Anchoring – Sail Trim – Reefing – Dead Reckoning – Celestial Navigation – Charts – Plotting – GPS – Radar – Radio – Computers – Cooking – Provisioning – Sewing – Sailmaking –– Weather/Meteorology – Electronics Repair – Diesel Engines/Repair – Outboard Engines – Fibreglass Repairs – Medical – Carpentry –

Other – please describe:

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What languages do you speak? ______________________________________

How would you rate your cooking skills?  Good _____ Average _____ Poor _____ Non-existent ______

What is your favourite meal to prepare for others aboard a boat or at home?

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What is your preferred drink (alcoholic and/or  non alcoholic) ______________________________________________________________

What are the principle reasons for you joining Tientos as crew?

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What do you wish to get out of this particular trip?

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Are there any judgements against you in the past or pending, in any jurisdiction?

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What are your main interests/hobbies?

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Please provide two (2) personal references and one (1) sailing reference if available.

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Medical Questionnaire

Name           _____         __     _______ Date of Birth    _____  

Age              Sex _____

Telephone ________________   Mobile _____________________________

E-mail ________________________________________________________

In case of emergency, notify_______________________________________

Relationship____________________________________________________

Day phone (___)____________________Mobile _______________________

MEDICAL HISTORY: Please explain all YES answers in detail, using an additional page if needed.

Do you have any existing medical conditions or problems? _______________

If so, please describe_____________________________________________

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Have you been hospitalised in the past 5 years ? If yes please explain__________________________________________________________________________________________________________
Do you take any medication regularly? If so, what type and for what condition_______________________________________________________

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Do you wear glasses or contact lenses?  _____________________________

How is your night vision ?__________________________________________

Have you experienced seasickness yet? _____  What are the most uncomfortable sea conditions you've encountered? ________________________________________________________________________________________________________________

Have you used prescription seasickness medications? If so, what type ?_________________________________________________________

Have you ever suffered any gastrointestinal disturbances including colitis, ulcers or stomach problems? If so, please describe. ______________________________________________________________

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Have you ever received psychological counselling or medication for depression or any other psychological challenges? If so, please describe. ______________________________________________________________

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Do you have any allergies, including allergic reaction to any drugs ?  _____ Which ones and to what effect? ________________________________________________________________

Have you ever been treated for alcohol or substance abuse? ___________

Do you have, or have you ever been diagnosed as having: diabetes, epilepsy, high blood pressure, high cholesterol, cardiovascular disease, migraines, asthma or lung disease, any significant back, knee, foot or leg problems, or any other diseases or conditions? _______ If so, please explain. ______________________________________________________________

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Name and telephone number of your Doctor __________________________

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