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| POSITION | |||
| Position applied for: | Deck cadet | Date | 12.03.2013 |
| Nomination for m/v | General cargo | Availability | |
| Applicant was interviewed by | Bogdanov Andrey | Desired min salary | 650$ |
| English level пптттт()()()()(satisfactorygood, bad) | Middle |
| PERSONAL INFORMATION | ||||||||||||||||||||||||||
| Ф.И.О. на русском языке | Богданов Анлрей Анлреевич | |||||||||||||||||||||||||
| Family name | Bogdanov | Permanent address | Kherson, Stepanovka, st. Zelenaya 67 | |||||||||||||||||||||||
| Name | Andrey | Post code | ||||||||||||||||||||||||
| Date of birth | 09.11.1993 | Phone home | ||||||||||||||||||||||||
| Place of birth | Crimea | Phone mobile | +380999017994 | |||||||||||||||||||||||
| Nationality | Ukrainian | E-mail address | batanik_baron@mail.ru | |||||||||||||||||||||||
| Tax ID number | Overall size: | S / M / L / XL / XXL | Shoes size: | |||||||||||||||||||||||
| Height / Weight | 177Framed/62kg | Hair/ Eyes: | Brown/Brown | |||||||||||||||||||||||
| EDUCATION BACKGROUND | From | To | Diploma No. | Highest qualification | ||||||||||||||||||||||
| Kherson Maritime College of Fish industry | ||||||||||||||||||||||||||
| FAMILY DETAILS | ||||||||||||||||||||||||||
| Next of kin(Last and first name) | Bogdanova Natalya Oleksandrovna | Next of kin relation | mother | |||||||||||||||||||||||
| Next of kin email | nata_bogd@mail.ru | |||||||||||||||||||||||||
| Next of kin address + post code | Kherson, Stepanovka, Zelenaya 67 | Next of kin contact phone 1st Next of kin contact phone 2nd | +380999016929 | |||||||||||||||||||||||
| Names of children | Sex | Date of birth | ||||||||||||||||||||||||
| Wife's full name (if married) | Wife's date of birth | |||||||||||||||||||||||||
| IDENTITY DOCUMENTS | Country | Number | Issued | Place | Expiry | |||||||||||||||||||||
| Civil passport | Ukraine | MP315126 | 09.03.2010 | Kherson | ||||||||||||||||||||||
| International Passport | Ukraine | EP595194 | 12.12.2012 | Kherson | 12.12.2022 | |||||||||||||||||||||
| Seaman’s Book Number of free pages:__ | Ukraine | AB500758 | 28.05.2012 | Kherson | 25.05.2022 | |||||||||||||||||||||
| Dutch | ||||||||||||||||||||||||||
| Seaman’s Book Number of free pages:30__ | Ukraine | 00241/2011/26 | 02.02.2011 | |||||||||||||||||||||||
| Do you hold a US VISA C1/D? | no | |||||||||||||||||||||||||
| Do you hold a Schengen Visa? | no | |||||||||||||||||||||||||
| CERTIFICATE OF COMPETENCY | Rank | Number | Place | Issued | Expiry | ||||||||||
| National License | |||||||||||||||
| National STCW Endorsement | |||||||||||||||
| National GMDSS certificate | |||||||||||||||
| GMDSS STCW Endorsement | |||||||||||||||
| Belize License | |||||||||||||||
| Malta License | |||||||||||||||
| Liberia License | |||||||||||||||
| Cyprus License | |||||||||||||||
| Dutch License | |||||||||||||||
| Other License | |||||||||||||||
| STCW CERTIFICATES | Number | Place | Issued | Expiry | |||||||||||
| Basic safety training (A-VI/1 STCW'95) | 6954/mps | 22.10.2010 | Kherson | 22.10.2015 | |||||||||||
| Proficiency in survival craft (A-VI/2 STCW'95) | 16627/mps | 22.10.2010 | Kherson | 22.10.2015 | |||||||||||
| Advanced fire fighting (A-VI/3 STCW '95) | 04716/mps | 22.10.2010 | Kherson | 22.10.2015 | |||||||||||
| Medical first aid (A-VI/4-1 STCW '95) | 2400/mps | 22.10.2010 | Kherson | 22.10.2015 | |||||||||||
| Medical care (A-VI/4 STCW '95) | |||||||||||||||
| Radar observer (ROPS) | |||||||||||||||
| ARPA certificate | |||||||||||||||
| Ship security officer (ISPS code) | |||||||||||||||
| Hazardous cargoes (B-V/4, B-V/5 STCW) | |||||||||||||||
| RO-RO other than passenger ships | |||||||||||||||
| Certificate re-validation course (II/2 STCW) | |||||||||||||||
| Certificate of ISM code (A-1/14) | |||||||||||||||
| Ship handling and maneuvering simulator | |||||||||||||||
| Compressed Air Breathing Apparatus | |||||||||||||||
| ECDIS (DECK OFF) | |||||||||||||||
| Bridge or Engine Resource Management | |||||||||||||||
| Bridge Team Management | |||||||||||||||
| Engine simulator | |||||||||||||||
| Maintenance of Electrical and Electronic Engin. | |||||||||||||||
| Ship's Welder | |||||||||||||||
| Ship's Turner | |||||||||||||||
| Ship's Cook | |||||||||||||||
| DP Certificate (indicate type) | |||||||||||||||
| PASSENGER SPECIFIC | Number | Place | Issued | Expiry | |||||||||||
| Crowd management (V/3, STCW) | |||||||||||||||
| Crisis man and human behavior (Ro, RoPax) | |||||||||||||||
| Pax, Saf, Cargo & Hull integrity | |||||||||||||||
| Pax Safety | |||||||||||||||
| RO-RO passenger ships (A-V/2 STCW) | |||||||||||||||
| Familiarisation training | |||||||||||||||
| TANKER SPECIFIC | Number | Place | Issued | Expiry |
| Tanker familiarization (V/1, A-V/1 STCW) | ||||
| Familiarization - Oil tanker (V/1 1.1-2, A-V/1 prg.1-7) | ||||
| Oil Tanker Advanced Training (V/1.2, A-V/1 STCW) | ||||
| Familiarization - Chemical tanker(V/1 1.1-2, A-V/1 prg.1-7) | ||||
| Chem. Tanker Advanced Training(V/1.2, A-V/1 STCW) | ||||
| Familiarization - LPG/LNG (V/1.2, A-V/1 STCW) | ||||
| LPG/LNG Advanced Training(Res.11,12, V/1.2, A-V/1 STCW) | ||||
| Crude oil washing (A.446/XI STCW, MARPOL) | ||||
| Inert gas | ||||
| Vapor Recovery Systems |
| TRAINING COURSES(any non STCW trainings, courses and etc.) | Location | Duration | Date |
| MEDICAL HISTORY | YES | NO | |||||||||||||||
| Medical pre-employment examination. | Issue date:04.07.2012 | Valid till:04.07.2013 | |||||||||||||||
| Drug and alcohol test. | Issue date:04.07.2012 | Valid till:04.07.2013 | |||||||||||||||
| Yellow fever vaccination. Valid till | Issue date: | Valid till: | |||||||||||||||
| Other vaccinations. Issue date: Valid date: Valid till | |||||||||||||||||
| (if the answer is YES to any of the above, please give full details and attach a separate signed and dated page if necessary) | |||||||||||||||||
| RECORDS OF PREVIOUS SERVICE(please give a full record starting from last vessel on which you served) | |||||||||||||||||
| Name of vessel | Flag | Year built | Vessel type | DWT | Engine type | KWT | Managers | Crewing agent | Rank | Signed on | Signed off | Months / Days | |||||
| BT-426 | Ukraine | Tug | 8.9 | Diesel | World Line LTD | World Line LTD | Deck Cadet | 06.06.2011 | 01.09.2011 | 3 months | |||||||
| Okski-56 | Ukraine | Dry-Cargo | 13.1 | Diesel | World Line LTD | World Line LTD | Deck Cadet | 26.05.2012 | 26.02.2013 | 9 months | |||||||
| REFERENCES:please, fill up on below rows the full address and phone number of your previous company | ||||
| Name of company Name of company: | World Line LTD | Address | Kherson, Krasnoflotskaya 35 | |
| Name of person to contact | Telephone number | |||
FOR OFFICE USE ONLY: references are  POSITIVE  NEGATIVE REQUEST REJECTED REFEREE NOT REACHED
| ||||
| Remarks: | ||||
| Name of company | World Line LTD | Address | Kherson, Krasnoflotskaya 35 | |
| Name of person to contact | Telephone number | |||
| FOR OFFICE USE ONLY: references are POSITIVE NEGATIVE REQUEST REJECTED REFEREE NOT REACHED
Name of company
Name of company:
Address
Name of person to contact
Telephone number
| ||||
| Remarks: |
Marlin's English test passed: Date: Professional test: Date
I hereby declare that above, including Medical History, is true. I accept any “EMES CREWING” investigation in my respect with any party concerned. Further, I confirm that I give the rights to “EMES CREWING” to share my personal data with any parties worldwide for service purposes or as required applicable legislation. I understand that my working contract will be canceled without notifying if any submitted information and document are voted as false.
Applicant signature_________________________ Place: ______________ Date_____________________
Дата добавления: 2015-11-14; просмотров: 43 | Нарушение авторских прав
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