38, Zhukovskogo Str., Odessa 65045, Ukraine, Phone [phone], e-mail: [e-mail]

	PHOTO

38, Zhukovskogo Str., Odessa 65045, Ukraine, Phone [phone], e-mail: [e-mail]

1^ST CHOICE:

MIN. SALARY:

2^NDCHOICE:

MIN. SALARY:

SURNAME:

FIRST NAME:

MIDDLE NAME:

DATE OF BIRTH:

PLACE OF BIRTH:

CITIZENSHIP:

NEAREST AIRPORT:

PERMANENT ADDRESS:

PHONE (HOME):

PHONE (MOB.):

E-MAIL:

MARITAL STATUS: Married / Single / Divorced

NEXT OF KIN (NAME / RELATION):

NEXT OF KIN (ADDRESS):

NUMBER / AGE OF CHILDREN: /

COLOUR OF EYES:

COLOUR OF HAIR:

SPECIAL MARKS:

HEIGHT: CM

WEIGHT: KG

OVERALL SIZE:

SHOES SIZE:

KNOWLEDGE OF ENGLISH: Fluent / Good / Satisfactory / Poor

OTHER LANGUAGES:

LICENSES & CERTIFICATES HELD

№

DATE OF ISSUE

DATE OF EXPIRY

PLACE OF ISSUE

CERTIFICATE OF COMPETENCY ()

PERMANENT

ENDORSEMENT OF CERTIFICATE

SEAMAN’S PASSPORT

TRAVEL PASSPORT

BASIC SAFETY

PROFICIENCY IN SURVIVAL CRAFT & RESCUE BOATS

ADVANCED FIRE FIGHTING

MED FIRST AID / CARE ON BOARD

SHIP SECURITY OFFICER (ISPS)

GMDSS

RADAR / ARPA

HAZMAT

TANKER CERTIFICATE (Oil / Chemical / Gas)

FOREIGN FLAG STATE SEAMAN’S BOOK

GRADUATED FROM:

DATE:

YELLOW FEVER (Date of Vaccination):

LAST MEDICAL EXAMINATION (Date of Expiry / Med Center): /

DETAILS OF PREVIOUS SEA SERVICE

RANK

COMPANY

FLAG

NAME OF VSL

TYPE OF VSL

TYPE OF ENGINE

DWT

BHP

FROM

TO

I HEREBY CERTIFY THAT ALL THE INFO CONTAINED HERE IN IS TRUE & CORRECT ANY MISREPRESENTATION WILL BE SUFFICIENT GROUND FOR DISQUALIFICATION & / OR DISMISSAL

Надаю згоду на збір, обробку та зберігання моїх персональних даних, а також передання моїх даних роботодавцю з метою пошуку роботи за кордоном, подальшим працевлаштуванням та інш.

Повідомлення отримав.

DATE: SIGNATURE

Дата добавления: 2015-09-30