APPLICATION FORM |
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Position Applied for | Deck Cadet/Junior | Alternative | 3rd Officer |
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Family name | Lazaryev |
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Given name | Volodymyr | |||||||||||||||||||||||
Fathers name |
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Date & place of birth | 14 Jun 92 Kherson | |||||||||||||||||||||||
USA visa valid till |
| Height 182 cm | Weight 72 kg | Overall size. | Shoes size 43 | |||||||||||||||||||
| Street | 2nd Slobodka 25 | ||||||||||||||||||||||
City/Country | Ukraine/Kherson | Airport(s) | Odessa/Boryspyl | |||||||||||||||||||||
Tel: | +380552513959 | Mobile | +3080990759917 | E-mail: |
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| Name / Relationship | Olena Lazaryeva | Date of birth | 07 Jun 69 | ||||||||||||||||||||
Street | 2nd Slobodka 25 | |||||||||||||||||||||||
City/Country | Ukraine/Kherson | |||||||||||||||||||||||
Tel | +380990759917 | Mobile | +380660420118 | E-mail: | vldimir.lazarev@gmail.com | |||||||||||||||||||
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| Dates attended | Type of Degree & Diploma | |||||||||||||||||||||
From | To | Received upon Graduation | ||||||||||||||||||||||
Kherson Maritime Collage | Ukraine/Kherson/Av.Ushakov 19/2, Kherson, 73000 Ukraine | Junior Specialist. Navigator | ||||||||||||||||||||||
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SEA SERVICE (from latest to previous)
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| Vessel’s type | Engine type | Flag | Company |
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DWT | HP | Year of built | Crew Agent | |||
Тх’’ом-106’’ |
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| S/on 30.07.2009 |
Kherson Maritime Collage | Kherson Maritime Collage | S/off 31.08.2009 | ||||
Тх’’ом-106’’ |
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| S/on 01.07.2009 |
Kherson Maritime Collage | Kherson Maritime Collage | S/off 29.07.2009 | ||||
Тх’’ом-106’’ |
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| S/on05.05.2010 |
Kherson Maritime Collage | Kherson Maritime Collage | S/off 24.08.2010 | ||||
Тх’’credo’’ |
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| S/on25.08.2010 |
Nikolaev | ТОВ “Тредиал шипинг” | S/off 20.02.2011 | ||||
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References: (state last management Company with telephone number and address)
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Above information is to the best of my knowledge and correct. (to be signed by the person, who completed the form)
Date. Si gnature.
DOCUMENTS / VISAS
Type of documents | Place of issue | Serial Number | Issue Date | Expiration date | |
Seaman’s book (National) | Nikolaev | 30.07.2009 |
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Travel. Passport | Kherson | ET549572 | 21.12.2011 | 21.12.2021 | |
USA Visa |
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Certificate. of Competency | №01499/2012/11 | Kherson |
| 21.11.2012 | |
Endorsement |
| 01499/2012/11 | 21.11.2012 | 24.05.2016 | |
GMDSS: |
| Kherson | № 2652/11 KH | 19.05.2011 | 19.05.2016 |
GMDSS Endorsement | Kherson | #00422/2012/11 | 21.11.2012 | 31.12.2016 |
STCW 78/95 CERTIFICATES / OTHER CERTIFICATES
CERTIFICATE | Issued on | Valid till | |||
Basic Safety Training (VI/1) | 27.03.2009 | 10.03.2014 | |||
Proficiency in survival craft & rescue boats (VI/2) | 23.12.2011 | 23.12.2016 | |||
Advanced fire fighting (VI/3) | 02.09.2011 | 02.09.2016 | |||
Medical First Aid (VI/4) | 02.09.2011 | 02.09.2016 | |||
Medical Care (VI/4) | 02.09.2011 | 02.09.2016 | |||
Dangerous and Hazardous Cargoes (B-V/b,B-V/c) | 24.05.2011 | 24.05.2016 | |||
Tanker familiarization | - |
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Oil advanced (V/1) | - |
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Chemical advanced (V/1) | - |
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Gas advanced (V/1) | - |
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IGS (Inert gas system) | - |
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COW (Crude oil washing: IMO model course 1.02) | - |
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Ship Security Officer (VI/5) | - |
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Ship Safety Officer (ISM Code) | - |
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AMOS for WINDOWS | - |
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Engine Resources Management | - |
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Bridge Team Management (IMO-model course 1.22) | - |
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Ship’s Handling (B-V/A) | - |
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Radar Navigation (Radar & ARPA) | 30.08.2011 | 30.08.2016 | |||
ECDIS | - |
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Cargo & Ballast handling | - |
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Dynamic Position 1, 2, 3 | - |
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VACCINATION | |||||
Yellow Fever | Date of vaccination: 24.10.12 | ||||
Hepatitis A, B | Date of vaccination: | ||||
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Date of readiness / Wage expectation and - Last salary | 14.02.2012 /500-700 | ||||
Дата добавления: 2015-09-30; просмотров: 14 | Нарушение авторских прав
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| Занятие из цветной бумаги «Веселая мозаика» | | | А где-то вдали, за всем сущим, |
