Following must be filled

ILC» Maritime crewing agency

Khruleva Street, Sevastopol

Phone: [phone], Email: [e-mail]

Skype: ilcshipping

APPLICANT’S PERSONAL DATA DATE

Contract length:

permanent short-term seasonal

Ready to work from

Average salary

USD

FIRST / LAST NAME:

MARITAL STATUS:

Photo

FATHER’S NAME:

NUMBER OF CHILDREN:

DATE / PLACE OF BIRTH:

NEXT OF KIN:

RELATIONSHIP:

CITIZENSHIP:

NEXT OF KIN ADDRESS:

ADDRESS:

SKYPE:

TEL:

МОB:

ТЕL:

МОB:

E-mail:

TWO NEAREST AIRPORTS

MARINE EDUCATION RECEIVED:

NAME OF SCHOOL	FROM	TILL	TYPE OF DEGREE RECEIVED

DOCUMENTS

PASSPORT	NO	DATE / PLACE OF ISSUE	VALID UNTIL
CIVIL
SEAMAN’S PASSPORT/ BOOK
SEAFARER'S IDENTITY DOC.
TRAVELLING PASSPORT
SHENGEN VISA
US VISA (C1/ D)

SERTIFICATE	NO	DATE OF ISSUE	VALID UNTIL	PLACE OF ISSUE
CERTIFICATE OF COMPETENCY
RANK
ENDORSEMENT
GMDSS
RANK
ENDORSEMENT
RADAR OBSERVER
ARPA
ECDIS
FOREIGN LICENSE / ENDORSEMENT
STCW, SPECIAL TRAINING
PERSONAL SAFETY AND SOCIAL RESPONSIBILITIES: A-VI/1-4
ADVANCED FIRE FIGHTING: A-VI/3
PROFICIENCY IN SURVIVAL CRAFT, RESCUE BOATS: A-VI/2-1
FIRST AID CERTIFICATE: A-VI/4-1/ MEDICAL CARE CERTIF.: A-VI/4-2
SECURITY AWARENESS TRANING OF SEAFARERS, (Section A-VI-6, table A-VI/6-1)
TRANING OF SEAFARERS WITH DESIGNATED SECURITY DUTIES (Section A-VI-6, table A-VI/6-2)
TRAINING OF SHIP SECURITY OFFICER (Section A-VI/5, table A-VI/5)
HAZARD MATERIALS CERTIFICATE
TANKER CERTIFICATE
CHEM.TANKER CERTIFICATE
SAFETY OFFICER TRANING CERTIFICATE
HEALTH CERTIFICATE rus/ eng
YELLOW FEVER
ENGLISH ABILITY(Х)
EXCELLENT	GOOD	MODERATE	POOR	NONE

LANGUAGE TESTS	RESULT	DATE
CES 4.1.
MARLINS

EXPERIENCE WITH MULTILINGUAL CREW	YES/NO	NATIONALITY

PRIOR SHIP EXPERIENCE (last 5 – 7 years)

Ship’s name	Owner	flag	Vessel’s type	GRT	Engines’ type	BHP	position	from	to

Experience in different positions: All experience:

Position	Years		Vessel's type	Years
			dry cargo
			tanker
			container vessel
			towboat
			passenger vessel

Following must be filled

ADDITIONAL INFORMATION ABOUT PREVIOUS EMPLOYERS (TEL / FAX / E-MAIL, CONTACT PERSON)	1.
2.

COLOUR OF:	SIZES:
HAIR	EYES	HEIGHT cm:	WEIGHT kg:	CLOTHES:	SHOES:

I HEREBY AFFIRM THAT ALL INFORMATION PROVIDED BY ME IN THIS APPLICATION IS TRUE AND CORRECT TO BEST OF MY KNOWLEDGE AND BELIEF

С автоматизированной обработкой моих персональных данных, указанных в анкете, их передачей третьим лицам (включая трансграничную) и хранением в целях трудоустройства в соответствии с Федеральным законом РФ N 152-Ф3 согласен, что подтверждаю заполнением и отправкой настоящей Анкеты — Applicant'spersonaldata. Также подтверждаю, что мои персональные данные являются общедоступными. signature of seaman

Дата добавления: 2015-10-28