Dangerous cargoes certificates. Position applied for: ___ab____

APPLICATION FORM

POSITION APPLIED FOR: ___AB____________

Personal data 05.01.2015

Family Name: Trufkaki	Name: Kostyantin	Father's name: Ivanovich
Date of birth: 13.08.1986	Place of birth: Ukraine,Odessa	Nationality: ukrainian
Marital status: married	Children (name & DOB): Trufkaki Vladislav 10.03.2012,Trufkaki Vladimir 20.10.2014
Address : Ukraine,Odessa Zabolotnogo str.,56 apt 5	Tel (including city code): [phone]	Mobile; [phone]
Next of kin and relationship: Trufkaki Anastasiya -Wife ,
Next of kin’s address: Ukraine,Odessa zabolotnogo str 56;apt 5	Tel:[phone]
Inter. P’port No: ER240454	Issued: 05.03.2014	Valid: 05.03.2024	Place of issue: UKRAINE
Seaman's book No: AB402145	Issued: 17/03/2014	Valid:17/03/2019	Place of issue: UKRAINE
Civil P’port No: KM069335	Place of issue: UKRAINE,ODESSA	Date of issue: 25.11.2002
USA Visa No:20131709020001	Issued:21/06/2013	Valid:21/06/2018	Place of issue:Ukraine

Medical information

Medical examination	Issued:	Valid:	Weight, kg:80	Height, cm: 175
Drug & alcohol test	Issued:	Valid:	Eyes: Brown	Hair: Black
Yellow fever	Issued:	Valid:	Overall size: 52	Safety shoes: 42

Name of marine school attended	Address of school	From	To	Degree of diploma
Odessa maritime college	Uspenskaya str 27	05/10/2009	Till now	Navigator

National License

Certificate of competency hold	Number	Issued	Valid	Place of issue
Диплом	10054/2014/08	26/03/2014	unlimited	Ukraine odessa
Endorsement

IMO	STCW Certificates	Number	Issued	Valid	Place of issue
	GMDSS Endorsement
	Carriage of dangerous and hazardous substances	1/900	25.02.2014	25.02.2019	ukraine
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)
2.03	Advanced fire fighting (A-VI/3)	2/549	26.02.2014	26.02.2019	Ukraine
1.23	Prof. in survival craft (A-VI/2 p.1-4)	3/126	25.02.2014	25.02.2019	Ukraine
	Designated security duties of shipboard personnel	9/618	25.02.2014	25.02.1019	Ukraine
	Basic training and instruction for all seafarers	3/703	25.02.2014	25.02.2019	Ukraine
	Crane Handling Simulator	CHS-172TC/14	13.04.2014	13.04.2019	Ukraine
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
	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
Therese Selmer		Staff Centre Marshall Islands Bulk Carrier 31222 OS 08.10.2008 08.04.2009	Marshall Islands	Bulk Carrier				OS	10.12.2007	08.07.2008
Therese Selmer		Staff Centre	Marshall Islands	Bulk Carrier				OS	08.10.2008	08.04.2009
Maersk Derince		Staff Centre	Germany	Container				OS	27.09.2009	21.01.2010
MSC Chiara		MSC	Panama	Container				OS	28.07.2010	25.02.2011
Beluga Tokio		Marlow Navigation	Liberia	Heavy Lift				OS	19.10.2011	23.02.2012
HHL Richards Bay		Marlow Navigation	Liberia	Heavy Lift				OS	16.05.2012	12.11.2012
Panthera		Marlow Navigation	Antigua and Barbuda	Heavy Lift				OS	01.07.2013	30.12.2013
Pancaldo		Marlow Navigation	Antigua and Barbuda	Heavy Lift				OS	26.04.2014	27.10.2014

Another States Seamen’s Books	Rank	Document No	Issued	Valid		Another States Certificates of competency	Rank	Document No	Issued	Valid
Liberia	os		03.08.2012	03.08.2017		Liberia
Panama						Panama
Antigua and Barbuda	os		06.102011	05.10.2016

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: 2015-07-26