POSITION:___ Motorman 2nd class___SALARY___1000-1200 USD____

APPLICATION FORM

POSITION:___________ Motorman 2^nd class_______________________________________________________________ SALARY ___1000-1200 USD____________

Surname: _________________ Kolchenko ______________ ^Прізвище: ________________________________________	Name: __________Maksym_____________________________ ^Ім^’^я^: __________________________________________________	Father's name:__________________Andreevich_________________________ ^По-батьков^і: ______________________________________________________
Date of birth: 03.02.1994	Place of birth: Nova Kahovka	Nationality: Ukraine	Nearest airport: Odessa
Address (permanent): Ukraine, Kherson region, Nova Kahovka, v. Topolivka, st.8 Marta,16	E-mail: [e-mail] skype: igroman1570	Mobil: [phone]
S4 Point Test:	Marlins test:	CES 5.2.2.:	Visas: no
Next of kin and relationship:	Marital status:
Next of kin’s address: Next of kin tel:	Next of kin’s phone:
Travel Passport: ER395735	Issued: 31.03.14	Valid: 31.03.2024	Place of issue: Kherson
Seaman's book: AB515468	Issued: 27.09.2013	Valid: 27.09.2018	Place of issue: Kherson
Civil Passport: MP310392	Issued: 24.04.2010	Place of issue: Kherson region, Nova Kahovka	ID Code: 3436709990
Education:

SEA GOING EXPERIENCE FOR THE LAST 5 YEARS

(MOST RECENT VESSEL LAST)

Name of vessel	IMO number	Year of built	Company Owner/ Ship Manager	Flag	Type of vessel	DWT	Main engine/ kW	Rank	From dd, mm, yyyy	To dd, mm, yyyy
“Helgis”			Selet Marine Limited Co.	Antigua and Barbuda W.I.	Container		Mak 8M551 4000kW	motorman	24.04.2014	10.12.2014

CERTIFICATE OF COMPETENCY

Type of document	Grade	Number	Issued	Valid	Place of issue
Motorman	2^nd class	№ 00347/2013	04.09.2013	31.12.2016	Kherson
Engineer	Third-class	№13962/2015/11	09.09.2015	31.08.2020	Kherson

СERTIFICATES

Type of certificates	Number	Issued	Valid	Place of issue
Basic Safety Training (VI/1)	№ 5708/MPS	07.08.2015	07.08.2020	Kherson
Proficiency in survival craft & rescue boats (VI/2)	№4587/MPS	07.08.2015	07.08.2020	Kherson
Advanced fire fighting (VI/3)	№12253 /MPS	07.08.2015	07.08.2020	Kherson
Medical First Aid/Medical Care (VI/4)	№2124/MPS	07.08.2015	07.08.2020	Kherson
Dangerous and Hazardous Cargoes (B-V/b,B-V/c)	№14566/MPS	07.08.2015	07.08.2020	Kherson
Ship Security Officer (VI/5)
GMDSS endorsement
Radar Navigation (Radar & ARPA)
ECDIS
Security awareness training for all seafarers (A-VI/6-1)
Designated security duties of shipboard personnel (A-VI/6-2)
Yellow fever vaccination	№466	01.04.2014	01.04.2024	Kherson
Engine-room resource management (Operetion Level)(B-VIII/2)	№4950/2015-A	13.08.2015	13.08.2020	Odessa

PERSONAL PARTICULARS

Hair	Eyes	Height	Weight	Overall size	Shoes
Brown	Brawn			no	43-44

REFERENCES

Name of Company/ Crewing agency	Phone number	Contact person

С автоматизированной обработкой моих персональных данных указанных в анкете, их передачей (включая трансзаграничную) и хранением в целях трудоустройства согласен. Подпись_____Кольченко М.А.___

Дата добавления: 2015-11-04