Application form

1. Position

Second class motorman

2. Filled

100%

3. Ready

At any time

In accordance with seaman’s book in English language
4. Surname	Dobriian	5. First name	Serhii
6. Father name	Andriyovych	7. Citizenship	Ukrainian
8. Date of birth	31.01.1997	9. Place of birth	Zaporizhia region, Ukraine
10. Nationality	Ukraine	11. Religion	Orthodox
12.Home address	№135, Gagarina Str., village of Kyibushevo, Zaporizhia region, 71000/71001, Ukraine	13.Personal details ^(in Ukrainian units of measurements)
(apartment, building, street, city, region, postal zone, country)	Hair	Blonde
14.Phone/Mobile /E-mail	[phone](main number); [phone]; [phone]	Eyes	Green
[e-mail]	Height
15.Marital status	Married Divorced Single (Never married) Separated Widowed	Weight
16.Children’s	Under 18 Yrs: Dates of birth:	Headdress
17.Next of kin /Relation	Relation: Dobriian Andrii Dmytrovych(father) - 0994631288, Dobriian Natalya Vladimirovna(mother).	Shoes size	42-43
(relation, surname, name, father name)	Overall size	S
18.Next of kin address	№135, Gagarina Str., village of Kuibyshevo, Zaporizhia region	19.Distinguish marks
(apartment, building, street, city, region, postal zone, country)
20.Agency remarks
Expected Wage: about 500 dollars for month

Ukrainian Educational diploma
Speciality	Educational Institute name (22.) and address (23.)	Diploma	Issued	Higher
21. Motorman	22. Nikolaev centre of training of seafarers   23.№2, Morekhidna Str., Nikolaev, Ukraine, 54021	24. Certificate of awarding (improving) of trade qualification Motorman № 059657	25. 11.03.2015

Ukrainian Certificate of Competency and Endorsement
Speciality	Given by	Number	Issued	Valid
26. Motorman	27. Certificate of awarding (improving) of trade qualification Motorman № 059657	28. 059657	29. 11.03.2015	30.
31.Second class motorman	32. CERTIFICATE OF PROFICIENCY	33. 11686/2015/07	34. 06.07.2015	35.

English(degree/mark)

FLUENT

GOOD

FAIR

BASIC

Other languages

36.A little French, Russian and Ukrainian - fluent

Ukrainian Passports and Medical documents
Document	37.Number	38.Issued	39.Valid	40.Issued Place
Ukrainian passport	СЮ297822	27.03.2013		Kuibyshevo RS UGMS Ukraine in Zaporizhia region
Travel passport		FA324538	08.05.2015	08.05.2025	Authority - 4801
Seaman’s Record Book	№ 00158/2015/26	09.02.2015		Nikolaev
Medical Certificate of Seaman	№ СА 181-15	13.05.2015	13.05.2016	Nikolaev Medical Center
Seaman’s book	АВ541509	02.03.2015	02.03.2020	Port Nikolaev
Drug and alcohol
Yellow fever

Previous sea service

41.Sea service since

42.Name of vessel

43.Flag

44.Type

45.Dwt

46.Engine

47.HP

48.Owner

49.Rank

50.From

51.Till

GS-82

UKR

Hydrographic

2x820

Ukraine, Nikolaev region Goshydrographic

Trainee-motorman

23.12.14

28.02.15

52.Remarks:

Produced being on a working watch under the direction of Chief engineer

Ukrainian STCW – 78/95 and other certificates.
Document	53.Number	54.Issued	55.Valid	56.Issued Place
Basic Safety Training		17.12.2014	17.12.2019	Ukraine, Nikolaev Centre of Training of Seafarers
Proficiency in Survival Craft
Proficiency in Fast Rescue Boats
Security duties of shipboard
Security related training
Advanced Fire Fighting
Medical First Aid
Medical Care
GMDSS Certificate
GMDSS Endorsement
Radar Observation & Plotting
Automatic Radar Plotting Aids
Dangerous & Hazardous Cargoes
Hazardous materials
Ships Safety Officer
Ships Security Officer
Isolating Breathing Apparatus
RO-RO Passenger Ship
RO-RO Ship
Oil Tanker Familiarization
Oil Tanker Specialized Training
Gas Tanker Familiarization
Gas Tanker Specialized Training
Chem. Tanker Familiarization
Chem. Tanker Specialized Training
Crude oil washing
Inert Gas Systems
Bridge Resource Management
Vapor Recovery Systems
Refresher & Updating
Maintenance of electrical and electronic engineering
ISM code

Flag state passports, licenses, visas and other documents
Document name/Details	Number/Comment	Issued	Valid	Issued Place
57.	59.	61.	62.	63.
58.	60.

Reference
Extra Master
Extra Chief Engineer

Signature of Seaman ____________________ Operations manager ____________________

Дата добавления: 2015-10-28