Seafarer application form

SEAFARER APPLICATION FORM

SURNAME	Zhuravel	RANK:	AB
FIRST NAME	Igor	Second Language:	ENGLISH
Date of Birth	28/06/1991	Place of Birth	Sevastopol	Nationality	Ukraine
Marriage status	single	Next of Kin	Zhuravel Irina	[phone]
Permanent Address:	Geroev Stalingrada 33 app 169 Sevastopol, Russia
Phone No:	[phone], [phone] [phone]
E-mail	[e-mail]

Document	Number	Date and Place of Issue	Date of Expiry
Civil Passport	EK375692	29/07/2009 Sevastopol	29/07/2019
Seaman’s Passport	AB 390847	17/09/2008 Sevastopol	22/08/2018

Type of Certificate	Number	Date and Place of Issue	Date of Expiry
Certificate of PROFICIENCY: Able seafarer deck	10423/2014/11	30.04.2014 Sevastopol
DESIGNATED SECURITY DUTIES OF SHIPBOARD PERSONNEL	UMA 5011	03.04.2014 Sevastopol	02.04.2019
SAFETY FAMILIARIZATION, BASIC TRAINING AND INSTRUCTION FOR ALL SEAFARERS	UMA 411	03.04.2014 Sevastopol	02.04.2019
Advanced Fire Fighting	UMA 410	03.04.2014 Sevastopol	02.04.2019
Proficiency in Survival Craft Rescue Boats	UMA 316	03.04.2014 Sevastopol	02.04.2019
Tanker Familiarization Course	UMA 063	27/06/2013 Sevastopol	31/12/2016
Medical First Aid on Board Ship	15962/2010/25/05	17/06/2010 Sevastopol	17/06/2015
Medical Certificate		19.11.2013 Sevastopol	19.11.2014
Yellow Fever Vaccination		03/03/2009 Sevastopol	03/03/2019

Rank	Vessel’s Name	DWT	Type	Flag	Owners	From	Till
Deck Cadet	Ivan Bubnov		Tanker	Russia	БРМСО	22/04/2009	18/07/2009
Deck Cadet	CP Балта		Dry Cargo	Ukraine	ВМС Украины В/ч А-4424	01/09/2009	08/11/2009
Deck Cadet	Ivan Bubnov		Tanker	Russia	БРМСО	04/12/2009	22//02/2010
Deck Cadet	AVIVA		RO-RO	Belize	Stonehill Maritime	26/03/2011	03/04/2011
Ordinary Seaman	LEO STAR I		Bulk Carrier	Liberia	Asterismos Navigation Corparation	31/07/2011	11/10/2011
Ordinary Seaman	SINEGORSK		General cargo	VANUATU	Mintaka Over Seas ltd	22/11/2013	19/03/2014

SEA SERVICE

SIZES

CLOTHES: 46	SHOES: 42	HEIGHT: 179
WEIGHT: 65	EYES COLOR: green	HAIR COLOR: brown

Дата добавления: 2015-11-04