Employment application form

Employment application form

date: 20.06.2015

Position applied for	ordinary seaman (os)
Date of availability	1 July 2015
Surname	ZOLOTAROV
Name	HRYHORII
Date / place of birth	03.06.1994 CRIMEA, Sevastopol
Marital status	NOT MARRIED
Marlins test	75%
Other Foreign languages

PHOTO

Contact information

Home address	Sevastopol city, October Revolution Prospect 22/5, 35
Mobile phone	[phone]
E-mail	[e-mail]

personel details & uniform information

Hair Colour	BLACK
Eye Color	BLUE
Height (CM)
Weight (Kg)
Working Clothes (EUR)	50-52
Shoes (EUR)	43-44

PRE-SEA EDUCATION

Name of school or academy	Department	From	To
Sevastopol Naval Academy named after P.S. Nakhimov 5-d year	Navigation and ship’s expluatation	01.09.11	30.06.15

seamen’s Documents

Name of document		Number	Place of issue	Date of issue	Date of expire
Foreigner Passport		EX279635	Sevastopol	27.07.13	27.07.23
Seaman’s Book		AB516431	Port Sevastopol	14.05.13	07.05.18
Certificate of Competency		00035/2013/10	Sevastopol	01.02.13	27.09.16
Endorsement		00035/2013/10	Sevastopol	01.02.13	27.09.16
Seamen’s seagoing service Record book		03589/2011/25	Sevastopol	16.11.11
A.R.P.A
ISM Code
Basic First Aid
Basic Fire Fighting
PSSR
Personal Survival Techniques
Advanced fire-fighting	A-VI/3	1326/2013	Sevastopol	25.11.13	25.11.18
Medical Care/first aid	A-VI/4, A-VI/4-1	1019/2013	Sevastopol	27.11.13	27.11.18
Prof. Survival Craft / Rescue Boats	A-VI/2/2-1	1945/2013	Sevastopol	27.11.13	27.11.18
Basic Safety Training and Instruction	VI/1, A-VI/1, B-VI/1	1696/2011	Sevastopol	27.09.11	27.09.16
Prevention of Pollution – Marpol
Designated security duties of shipboard personnel	VI/6, A-VI/6, A-VI/6-2	0949/2013	Sevastopol	25.12.13	25.12.18
SSO (Ship Security Officer)
Bridge Team Management
GMDSS
Seafarers Medical Vaccination against Yellow Fever			Sevastopol	12.02.14
US C1/D Visa

Rank	Owner	Name of vessel	Flag	Type	DWT	From	To
ordinary seaman	Naval Forces of Ukrain	« Korets»	UKRAINE	Tug		12.01.12	13.03.12
ordinary seaman	Sevastopol Naval Academy named after P.S. Nakhimov.	« Nova Kakhovka »	UKRAINE	Training vessel		14.02.12	15.04.12
Able seamen	JSC «Rosshipcom»	m/v «Capitan Korchin»	RUSSIA	Dry cargo ship		03.10.14	20.03.15

Applicant signature: ZOLOTAROV

Дата добавления: 2015-08-27