54017, Ukraine, Nikolaev, pr. LENINA, 70/18.

	Pulsar Service Marine agency 54017, Ukraine, Nikolaev, pr. LENINA, 70/18. phone [phone] Phone/fax: [phone]. Skype: pulsar-servicemk E-mail: [e-mail] License: AB 487508 issued 12.01.10
	Position applied for:	Date available:
	Surname
	name
	Father's Name
	Date and place of birth
	Address, (	City:	Street/Ave:
	Personal civil code:	House: Apt:	Mob (:
	Height:	Weight:	Overall:	Shoes:	Eyes:	Hair:
	E-Mail:	ICQ:	SKYPE:
	Yellow Fever valid
	Title of the document	№	Date	place of issue	Valid up
	Seaman's book
	National passport
	Foreign passport
	Cyprus passport
	Panama passport
	Other passport
	Certificate of competency
	Rank	Deep sea navigator
	Endorsement
	GMDSS operator
	Endorsement
	Basic Safety Training STCW-95
	Advanced Training in Fire Fighting
	Medical Emergency - First aid
	Proficiency in Survival craft
	Medical Care on Board Ship
	Radar Navigation-Managemen Level
	Ship Handling Arrangements
	Ships Security Officer A
	Ships Security Officer A, B
	Electronic Chart Display And Information System
	Oil Tanker Familiarition
	Dangerous and Hazardous Substan.
	Other foreign languages	Second (relative) specialty
	Lathe machine skills	Welding skills
PC knowledge Certificate	Valid USA visa

PREVIOUS SEA EXPERIENCE (FOR LAST 5 YEARS):

RANK	NAME OF THE VESSEL	TYPE VESSEL	YEAR OF BUILD	DWT	TYPE OF THE MAIN ENGINE	FROM	TILL	COMPANY
FLAG	HP

MARINE EDUCATION RECEIVED

NAME OF SCHOOL	FROM	TILL	TYPE OF DEGREE RECEIVED

Additional information

Marital status:	Religion:
Wife (Name, First name, Date and place of birth)
Children under the age of 18 (names, date of birth)
Next of kin (Name, date of birth, address, phone #)

Level English test

English language knowledge	Excellent		Good		Satisfactory		Poor
Computer proficiency	Excellent		Good		Satisfactory		Poor

I, undersigned, confirm all above information to be true and correct to my best knowledge:

Signature of the Applicant ________________

Дата добавления: 2015-09-29