RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE | |||||||||||||||||||||||
Name in full(First, Middle, Last) Shabash Artur Yuriiovych | Rank: Deck cadet 2nd choice: OS | Min. Wage: negotiable |
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Date & place of birth: 18.01.1996 from Cherkassy
| Nationality: Ukraine
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Marital Status: | Single | Married | Divorced | Widower | Nearest Airport: Borispol
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Permanent Address: - Cherkassy, Chygyryns'ka street, dom 40, kv. 25
E-mail: Shabashzzz@yandex.ua Tel: +380508327978 Mob: | Next of kin (surname, name, date of birth): Shabash Olena 03.08.1972
Relationship: Mother Address: Cherkassy, Apartment 40,Chygyryns'ka street,kv.25 | Children (surname, name, date of birth): 1.
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Colour of hair/eyes: black/blue | Height: | Weight: | Shoes size: | Clothes size: M | |||||||||||||||||||
Educational History (name of educational institution, dates of entry / graduation and degree ): Kherson State Maritime College
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YELLOW FEVER VACCINATION: | |||||||||||||||||||||||
Country of issue | Number: | Date issued: | Place issued: | Expiry Date: | Remarks | ||||||||||||||||||
Ukraine | 23.01.2015 | Kherson | 23.01.2025 |
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LICENCE INFORMATION: | |||||||||||||||||||||||
Country: | Grade of Licence: | Number: | Date issued: | Place issued: | Expiry Date: | ||||||||||||||||||
National
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Marshall Islands |
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STCW 78\95 CERTIFICATES | |||||||||||||||||||||||
Type of Documents | Reg. | No: | Place of Issue | Date of Issue | Date of Expiry | ||||||||||||||||||
Basic safety training STCW’ 78/95 | A-VI/1 | 22660/14KH | Kherson | 17.01.2014 | 17.01.2019 | ||||||||||||||||||
Advanced Fire Fighting | A-VI/3 | 11241/14KH | Kherson | 26.09.2014 | 26.09.2019 | ||||||||||||||||||
Proficiency in Survival Craft | A-VI/2 | 17596/14KH | Kherson | 07.02.2014 | 07.02.2019 | ||||||||||||||||||
Medical First Aid | A-VI/4-1 | 9039/14KH | Kherson | 26.09.2014 | 26.09.2019 | ||||||||||||||||||
Security Awareness Training | A-VI/6-1 | 3629/14KH | Kherson | 03.03.2014 | 03.03.2019 | ||||||||||||||||||
Designated Security Duties | A-VI/6-2 |
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Medical Care | A-VI/4 |
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HAZMAT / Dangerous Cargoes | B-V/b,c |
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Ship’s Safety Officer | ISM Code |
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Ship’s Security Officer | ISPS Code |
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Electrical and Electronic Equip. | A-III/2 |
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Ship Handling Arrangements | A-II/1, 2 |
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Tanker Familiarization | A-V/1 |
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Oil Tanker Training | A-V/1 |
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Chem. Tanker Training | A-V/1 |
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Inert Gas System | MARPOL |
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C.O.W. | MARPOL |
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Radar Navigation | A-I/11,12,A-II/2,3 | 2781/15KH | Kherson | 16.01.2015 | 16.01.2020 | ||||||||||||||||||
GMDSS | IV/2 | 3597/14KH | Kherson | 21.11.2014 | 21.11.2019 | ||||||||||||||||||
GMDSS Endorsement | IV/2 |
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Bridge Team | A-II/1,2, B-VIII/2 | 0726/15KH | Kherson | 06.03.2015 | 06.03.2020 | ||||||||||||||||||
Large Ship’s Handling |
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ECDIS | A-II/1, 2 | 2388/15KH | Kherson | 30.01.2015 | 30.01.2020 | ||||||||||||||||||
DP Certificate |
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BOSIET | OPITO |
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HUET | OPITO |
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Drug&Alcohol Test |
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Medical Examination |
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Vaccination Yellow Fever |
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SEAMAN’S & PASSPORT BOOK INFORMATION: | |||||||||||||||||||||||
National Seaman’s Book (ULM) No: | Place & Date Issued: | Expiry Date: | Ukrainian Passport No: | Place & Date Issued: | Expiry Date: | ||||||||||||||||||
AB515840 | Kherson /21.01.2014 | 20.12.2018 | HE681752 | Chygyryn/12.02.2013 |
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Marshall Islands Seaman’s Book No: | Place & Date Issued: | Expiry Date: | Civil Travel Passport | Kherson/ 28.02.2014 | 28.02.2024 | ||||||||||||||||||
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| ER226855 |
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VISA INFORMATION: | |||||||||||||||||||||||
| Visa: | Type: | Valid Until: | Remarks: | |||||||||||||||||||
American |
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Schengen |
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LANGUAGE INFORMATION: | |||||||||||||||||||||||
Good | Satisfactory | Poor | Remarks | ||||||||||||||||||||
English | Good |
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Other |
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Availability for Service: 14.08.2015
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RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE | ||||||||||
RECORD OF SEA SERVICE | ||||||||||
Vessel | Flag | IMO Number | DWT / M.E Type, kW | Vessel Type | Rank | From (date-month-year) | To (date-month-year) | Months | Company | |
Om-106 | Ukraine | 1-020560 | 21.5DWT/3D12/2x220kWt | passenger | OS | 27.04.2014 | 31.08.2014 | KSMA | ||
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I hereby provide that all the information provided by me in this form is true and correct to the best of my knowledge.
Signed by Seaman: |
Date:14.08.2015 | |||||||||
References:
Company / Contact person / Telephone number
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С автоматической обработкой моих персональных данных, указанных в анкете, включая их передачу третьим лицам на территории нашей страны и за ее пределами, их хранением в целях трудоустройства, в соответствии с Законом СОГЛАСЕН.
Подтверждаю, что мои персональные данные, указанные в анкете, являются общедоступными.
I hereby give my consent to automatic processing of the information contained herein, including its transfer to third parties in the territory our country and abroad, as well as its storage for the purposes of employment assistance, in accordance with the Law.
I hereby confirm that my personal details contained herein are for public use.
Signature of Seaman (подпись моряка): _________________ Date (дата): 14.08.2015
Дата добавления: 2015-11-04; просмотров: 16 | Нарушение авторских прав
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