Seafarer's application form

SEAFARER'S APPLICATION FORM

photo

NAME

Tim

SURNAME

Bosko

DATE OF BIRTH

23.11.1984

PLACE OF BIRTH

Russia,Krasnoyarsk

NATIONALITY

Ukraina

CONTACT PHONE

[phone]

CIVIL STATUS

Mar

MOBILE PHONE

NEXT OF KIN

EMAIL

[e-mail]

HOME ADDRESS

Ukraine,Mariupol

POSITION APPLIED FOR

AB,OS

AVAILABLE FROM

01.12.2014

LEVEL OF ENGLISH

Good

USA VISA VALID

more info

SEA SERVICE RECORD FOR THE LAST 5 YEARS

RANK

TYPE OF VESSEL

NAME OF VESSEL

FLAG

GRT

MAIN ENGINE TYPE AND POWER

SHIPOWNER / CREWING

SIGNED ON/ SIGNED OFF

OS

Bulk

Idil

Panama

New Star Shipping Group S.A/Epsilon

13.11.12/13.09.13

OS

Bulk

Idil

Panama

New Star Shipping Group S.A/Epsilon

17.12.13/14.07.14

OS

Bulk

Universal Bangkok

Valletta

Behermaat scappi m.s. universal bangkok,b.v

16.12.14/19.05.15

DOCUMENTS

NUMBER

ISSUED

VALID

COUNTRY

FOREIGN PASSPORT

PO 456695

14.07.2006

14.07.2016

Ukraine

NATIONAL PASSPORT

VS 881218

03.03.2001

Ukraine

NATIONAL SEAMAN’ S BOOK

AB 453213

28.09.2010

22.07.2015

Ukraine

LICENSE

10939/2014/06

14.10.2014

Ukraine

BASIC SAFETY TRAINING

21438MA

11.09.2014

11.09.2019

Ukraine

PROFICIENCY IN SURVIVAL CRAFT

17135MA

15.09.2014

15.09.2019

Ukraine

ADVANCED FIRE FIGHTING

14477MA

18.09.2014

18.09.2019

Ukraine

DESIGNATED SECURITY DUTUES OF SHIPBOARD PERSONNEL

10626KC

28.11.2013

28.11.2018

Ukraine

SECURITY RELATED TRAINING AND INSTRUCTION FOR ALL SEAFARERS

4115KC

27.11.2013

27.11.2018

Ukraine

Дата добавления: 2015-11-04