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APPLICATION FORM
POSITION APPLIED FOR: Motorman
Personal data 28.11.2014
Family Name: Valevych | Name: Andrii
| Father's name: Nikolay | ||||||
Date of birth: 06.11.1982 | Place of birth: Kherson
| Nationality: Ukraine | ||||||
Marital status: single
| Children: none
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Address : Ukraine, Kherson, Kamyshany, Mekhanyzatorov 8.
| Tel
| Mobile; +380508522212
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Next of kin and relationship: Nikolay .-father, Elena .-mather | ||||||||
Next of kin’s address : | Tel: | |||||||
Inter. P’port No:EK491090 | Issued: sep 09 | Valid: sep 19 | Place of issue: Kherson | |||||
Seaman's book No: AB542200 | Issued :okt 14 | Valid: sep 19 | Place of issue: Kherson | |||||
Civil P’port No: MO 668972
| Place of issue: mar 99
| Date of issue:
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USA visa No: | Issued: | Valid: | Place of issue: | |||||
Medical information
Medical examination | Issued:sep 14 | Valid:sep 15 | Weight, kg :70 | Height, cm: 176 |
Drug & alcohol test | Issued: jan 15 | Valid: jan 16 | Eyes:green | Hair: brown |
Yellow fever | Issued: | Valid: | Overall size: | Safety shoes: 42 |
Name of marine school attended | Address of school | From | To | Degree of diploma |
Training centre “AVANT” | Illichivsk | 01.11.13 | 15.05.14 |
National License
Certificate of competency hold | Number | Issued | Valid | Place of issue |
Диплом | 12308/2014/11 | 06.11.2014 |
| Kherson |
Endorsement |
IMO | STCW Certificates | Number | Issued | Valid | Place of issue | ||
GMDSS Endorsement | |||||||
| Carriage of dangerous and hazardous substances | ||||||
1.08 | ARPA (A-I/12, A-II/1, A-II/2, B-I/12) | ||||||
Personal safety (A-VI/1) (IMO 1.13, 1.19, 1.20, 1.21) | No. 20 570 | 08.08.2014 | 08.08.2019 | Illichivsk | |||
2.03 | Advanced fire fighting (A-VI/3) | ||||||
1.23 | Prof. in survival craft (A-VI/2 p.1-4) | No. 16 244 | 08.08.2014 | 08.08.2019 | Illichivsk | ||
1.14 | Medical first aid (A-VI/4-1) | ||||||
1.15 | Medical care (A-VI/4-2) | ||||||
Hazardous cargoes (B-V/4, B-V/5) | |||||||
Security avareness(A-VI/6) | No.20 387 | 08.08.2014 | 08.08.2019 | Illichivsk | |||
Crowd management (A-V/3) | |||||||
| Bridge Team Management | ||||||
| Training for person. serving onpassenger ships other than RO-RO pas.ships | ||||||
| Designated security duties of shipboard personnel | № 29451/MPS | 26.12.2014 | 26.12.2019 | Kherson | ||
| Ship security officer | ||||||
| Ship handling arrangements |
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| Свид-ство о повышении квалификации |
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Dangerous cargoes certificates
1.01 | Oil tank. familiarization (A-V/1) |
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1.02 | Oil tank.Specialized training (A-V/1,p.9-14) | ||||
1.03 | Chem. tank. familiarization (V/1) |
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1.04 | Chem. tank. advanced (A-V/1,p.16-21) |
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1.05 | LPG familiarization (V/1) |
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1.06 | LPG advanced (A-V/1,p.23-34) |
PREVIOUS SEA SERVICES (last 5 years)
Name of vessel | Year of built | Company | Flag | Type of vessel | DWT | Type of main engine | BHP | Rank | From Day,mont,year | To Day,month,year
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m/v “Diorit” | “Black Sea State” | ukr | Reserch/ Survey | SKL 48V8 | cadet | 11.03.2014 | 13.05.2014 | |||
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Another States Seamen’s Books | Rank | Document No | Issued | Valid |
| Another States Certificates of competency | Rank | Document No | Issued | Valid |
Liberia |
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| Liberia |
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Panama |
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| Panama |
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Please complete addresses of your previous employers for references
Company |
«» | Tel: | Company |
| Tel: |
Address | Address |
Signature____________________ Date ________________ I understand, that my working contract will be canceled without notifying if any of submitted information and documents are voted as false.
FOR OFFICIAL USE ONLY English abilities: Good: Average: Poor:
(To be filled by Company’s authorised personnel) 10 9 8 7 6 5 4 3 2 1
Good spoken and written Understand basic instructions Do not understand basic instructions
Дата добавления: 2015-08-27; просмотров: 36 | Нарушение авторских прав
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