Dangerous cargoes certificates. Position applied for: _mes/boy___o/s ___a/b____

APPLICATION FORM

POSITION APPLIED FOR: _mes/boy_______o/s ___A/b____

Personal data30/04/2015­­­­­

Family Name: Petrov	Name: Sergii	Father's name: Oleksandrovych
Date of birth: 28/02/1989	Place of birth:Mariupol	Nationality: Ukraine
Marital status:	Children (name & DOB):
Address : Ukraine/Mariupol/50let sssr 20/58	Tel (including city code): [e-mail]	Mobile; [phone]
Next of kin and relationship: .-father,.-matherOtrisko Lyudmila
Next of kin’s address: Ukraine/Mariupol/50let sssr 20/58	Tel:[phone]
Inter. P’port No: EE 773073	Issued: 09/12/2008	Valid: 09/12/2018	Place of issue: Mariupol
Seaman's book No: Ab 421973	Issued: 16/03/2009	Valid:24/07/2018	Place of issue: Mariupol
Civil P’port No: Vk 281486	Place of issue: Ukraine/Mariupol	Date of issue: 10/04/2006
USA visa No:	Issued:	Valid:	Place of issue:

Medical information

Medical examination	Issued:13/10/2014	Valid:13/10/2016	Weight, kg:92	Height, cm: 178
Drug & alcohol test	Issued:13/10/2014	Valid:13/10/2016	Eyes: grey	Hair: bleak
Yellow fever	Issued: 08/04/2009	Valid:08/04/2019	Overall size: 58	Safety shoes: 44

Name of marine school attended	Address of school	From	To	Degree of diploma
Training Centr of Seafare rrrr aa s	Avant Illichivsk	13/01/2012	22/06/2017

National License

Certificate of competency hold	Number	Issued	Valid	Place of issue
Диплом	00254/2012/06	09/08/2012	31/12/2016	Mariupol
Endorsement	00254/2012/06	09/08/2012	31/12/2016	Mariupol

IMO	STCW Certificates	Number	Issued	Valid	Place of issue
	GMDSS Endorsement
	Carriage of dangerous and hazardous substances	3/215/12	17/05/2012	17/05/2017	Illichivsk
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)	3/613/12	22/06/2012	31/12/2016	Illichivsk
2.03	Advanced fire fighting (A-VI/3)
1.23	Prof. in survival craft (A-VI/2 p.1-4)	3/456/12	22/06/2012	22/06/2017	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)
	Safety officer (ISM code)
	Crowd management (A-V/3)
	Bridge Team Management
	Training for person. serving onpassenger ships other than RO-RO pas.ships
	RoRo passenger (A-V/2-1,-2,-3,-4,-5)
	Ship security officer		26/03/2014	26/03/2019	Mariupol
	Ship handling arrangements
	Свид-ство о повышении квалификации

Dangerous cargoes certificates

1.01	Oil tank. familiarization (A-V/1)
1.02	Oil tank.Specialized training (A-V/1,p.9-14)
1.03	Chem. tank. familiarization (V/1)				.
1.04	Chem. tank. advanced (A-V/1,p.16-21)
1.05	LPG familiarization (V/1)
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
ATHOS		helikon	Caiman islands	Bulk carrier		6630 kwt		Mes/boy	11/05/2009	07/11/2009
Parnassos		helikon	Caiman islands	Bulk carrier		14956 kwt		O/S	11/04/2010	10/09/2010
Evanthia		Grand harbor shipping ltd	valleta	Bulk carrier				O/S	08/06/2011	16/04/2012
Zografia		SEA Pearl maritime	valleta	Bulk carrier		5891 kwt		O/S	01/11/2013	26/05/2013
SEA ARROW		Allikmon marine inc	monrovia	Bulk carrier				Mess/boy	20/10/2014	24/04/2015

Another States Seamen’s Books	Rank	Document No	Issued	Valid		Another States Certificates of competency	Rank	Document No	Issued	Valid
Liberia	Mes/boy		29/10/2014	29/10/2019		Liberia
Panama	A/B		28/08/2013	28/08/2018		Panama

Please complete addresses of your previous employers for references

Company	«adriatiko-mariupol»	Tel:[phone]	Company	Panigo-ukraine	Tel[phone]:
Address		Address

Signature____________________ Date __30/042015____________­__ 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: 2015-07-26