The License of the Ministry of Labour AA № 217386, registered in Ukraine, № 30029469
«A1 LIGHTHOUSE OF THE BLACK SEA»
TEL/FAX+38(048) 729 3093 E-mail: light@te.net.ua
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APPLICATION FORM FOR DECK DEPARTMENT
Surname Malikov | Given Name Viacheslav | Date of birth 09.02.1988 | Place of Birth Odessa |
Position applied for: (1st choice / 2nd choice) OS / Messman Chief Eng. 2nd Choice | Nationality: | ||
Address: | Tel (Home): +380482474305 | Mobile: +380632743335 | |
English Language (Satisfactory) | Inquiry of Salary, min, USD |
National | Rank | Number | Date of issue | Place of issue | Date of expiry |
Certificate of Competency | OS | 00449/2012/03 | 20.07.2012 | Port Illichivsk | X |
Endorsement |
| 00449/2012/03 | 20.07.2012 | Port Illichivsk | 13.02.2017 |
Seaman’s Book | X | AB 482709 | 13.08.2012 | Port Illichivsk | 13.08.2017 |
International Passport | X | ET 724158 | 21.02.2012 | Odessa | 21.02.2022 |
Foreign Country Docs: | |||||
Endorsement |
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Seaman’s Book |
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Sea service (from cadet)
Period (month / year) | Position | Name of Vessel | Vessel Type | Type of cargo | Shipowner / Operator | |
From | To | DWT, TEUs | Nationality of Crew | Tel. and name of contact person | ||
20.03.2012 | 18.052012 | Deck Trainee | Novator | Tug |
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19.05.2012 | 15.08.2012 | Deck Trainee | Nastavnik | Tug, |
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LIST OF DOCUMENTS SUBMITTED (validity crosschecked)
STCW-78/95 CERTIFICATES: | No: | Date of issue | Place of issue | Date of expiry |
Passengers Ro-Ro ships1 | 01.06.12 | USTC | 01.06.17 | |
Tanker FAMILIRIZATION A -V/1-8 | 01.06.12 | USTC | 01.06.17 | |
BASIC SAFETY TRINING AND INSTRUCTION | 13.02.12 | USTC | 13.02.17 | |
Carriage of dangerous cargoes B -V/4-5 | 01.06.12 | USTC | 01.02.17 | |
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US Visa – validation |
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ISPS (Ship Security Officer) |
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BTM (Brige Team Management) |
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ISM Code |
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ECDIS(Electronic cart) |
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Date of issue | Place of issue | Date of expiry | |
Last medical examination | 14.02.2012 | VIVAMED | 14.02.2013 |
Yellow fever |
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Alcohol and drug test |
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Height: 187 | Weight: 75 | Eyes: blue | Uniform size: 56 | Shoes size: 44 | |
Special marks |
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Marital Status: Single | Children under 21: |
May we inquire about you from your former Employers? |
Next-of-Kin, Relation: Malikova Tatyana Yurievna, Mother |
ДОПОЛНИТЕЛЬНЫЕ ДАННЫЕ (ЗАПОЛНЯТЬ НА РУСКОМ ЯЗЫКЕ) |
Фамилия | Имя | Отчество | |
Адрес: | |||
Тel: | Mobile: | E-mail: @ | |
Фамилия контактного лица | Имя | Отчество | |
Тel: | Mobile: | E-mail: @ | |
От куда узнали про нас: | Кого Вы рекомендуете: | ||
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