Ryan Ship Management ltd

RYAN SHIP MANAGEMENT LTD

SHIPPING CONNECTIONS / (MARITIME RECRUITMENT) POSTAL ADDRESS:-RYANSHIP P O Box – 1282 - SUNDERLAND TYNE and WEAR SR5 9HX UNITED KINGDOM Tel: [phone] Fax: [phone] Email: [e-mail] www.shipping-connections.com

Application Form Deck & Engineering Officers

Section 1

Position

Position Applied for

3rd / 2nd / Engineer/Engine Room Operator /Single etc.

Lowest Position Acceptable

Engine Room Operator

Date of Availability

19/02/2014

Section 2

Personal Details

Family name / Surname

Fadin

First Name / Given Name

Oleg

Date & Place of Birth

Date - 27-08-1984 Place- Klaipeda

Nationality

Lithuanian

Permanent Address

Taikos av.102-14, Klaipeda; 93157

Present Address

Taikos av.102-14, Klaipeda; 93157; Lithuania

PPE information

SAFETY SHOES SIZE

COVERALL SIZE

Present Contact Number

[phone]

Mobile Number

[phone]

SKYPE ADDRESS

lluu-vvu

Email Address

[e-mail]

Nearest Airport (and Distance)

Palanga(27km)

Section 3

Passport and VISA details

Country of Issue

Lithuania

USA Visa - Type

B1/OCS

Date Issued

09.10.2008

USA VISA Expires

N/A

Place Issued

Klaipeda

USA Visa - Type

C1/D

Passport Number

USA VISA Expires

18.06.2018

Passport –Expires

09.10.2018

Other Country Visa

Russia

Secondary passport or Dual nationality

Visa Expiry

21/05/13

Section 4 (hi-light as required)

Seaman book / Discharge book / Seaman Record Book / CDC

Issuing Country & Place

Lithuania/Klaipeda

Date Issued

06.05.2011

Number

JK037756

Expiry Date (if any)

06.05.2016

Section 5

Next of Kin – this is important information we require- Don’t ignore it

Full Name / Relationship

Antonina Fadina

Any dependents / Children (incl age)

Address

Rambyno st.20-14, Klaipeda, Lithuania

Contact Numbers

[phone]

Page 1 of 7

Section 6 STCW95 Highest Certificate of Competency / Licence Held ( also list Flag State Endorsements )

Class / Grade/Capacity

Issuing Country

Certificate No.

Date Issued

Expiry

Details of Limitations

2nd/Eng (no limits)

Lithuania

D00139

20.12.2010

08.12.2015

(no limits)

2nd/Eng (no limits)

Italy

12.06.2012

08.12.2015

(no limits)

2nd/Eng (no limits)

UK

CEC0042404

23.09.2011

08.12.2015

(no limits)

2nd/Eng (no limits)

Dutch

14.11.2012

14.11.2022

(no limits)

ALSO ENTER ABOVE DETAILS OF ANY OTHER FLAG STATE CERTIFICATES HELD

Section 7 STCW95 Dangerous Cargo Endorsements

Petroleum……………. Liquefied Gas………. Liquid Chemicals…….

Certificate No.

Date Issued

Expires

Details of Limitations/ Grade

Section 8 STCW95 related Courses Attended and Certificates Obtained

Name of Course / Certificate

STCW Code

Place

Issue Date

Cert No

Expiry Date

Personal Survival Techniques

A- VI/1-1

Basic Sea Survival / Training

A-VI/1

Klaipeda

2009.03.16

827/2009

2014.03.05

Fire Prevention & Fire Fighting

A-VI/1-2

Elementary First Aid

A-VI/1-3

Personal Safety & Social Responsibility

A-VI/ 1-4

Proficiency in Survival Craft & Rescue Boats

A-VI/ 2-1

Klaipeda

2012.05.25

2936/2012

24.05.2017

Proficiency in RESCUE CRAFTS

Advanced Fire Fighting

A-VI/ 3

Klaipeda

2009.11.24

3694/2009

2014.11.19

Medical & First Aid

A-VI/ 4-1

Klaipeda

2012.05.25

2935/2012

24.05.2017

Medical Care (Ship Captains Medical Course)

A-VI/4-2

Radar & ARPA Simulator Trg- Management level

A-II/ 1-2

GMDSS + ENDORSEMENT

A-IV/ 2

SAFETY OFFICERS COURSE (SO)

Ship Security Officers Course (SSO) Issued under STCW95

A-VI/ 5

Medical Certificate / HEALTH Certificate

Klaipeda

13.12.2013

13.12.2014

Drug and Alcohal test certificate

YELLOW FEVER

01.08.2007

unlimited

Bridge Team Management

A-II/2

Bridge Resources Management

B-VIII/2

Electronic chart Display and Information System course (ECDIS)

ISM Code

A.1441 (18)

TANKERS FAMILIARISATION

A-V/1

Klaipeda

2009.02.27

619/2009

2014.02.25

Advanced Tanker Operations (Chem.)

A-V/1-2

Advanced Tanker Operations (Oil)

A-V/1

Advanced Tanker Operations (LPG)

A-V/1

INERT GAS

CRUDE OIL WASHING

Tanker Safety (petroleum)

Tanker Safety (Chemical)

Tanker Safety (GAS)

REFRESHER & UPDATING

I/II & III/2

Other????

Other????

Other????

Other????

Page 2 of 7

L I S T A L L O T H E R C O U R S E S Section 9 OFFSHORE INDUSTRY COURSES

Please enter below any other certificates held or courses done, ie offshore, DP certs etc or Any other not already mentioned

Name of Course / Certificate

APPROVALS

Place

Issue Date

Cert No

Expiry

BOSIET

PETROFAC

20/10/11

PTLMS

20/10/15

HUET

PETROFAC

20/10/11

PTLMS

20/10/15

FOET

PETROFAC

20/10/11

PTLMS

20/10/15

OFFSHORE MEDICALS (UK, NORWAY or NETHERLAND)

Re-Breather training

Initial Standby vessel crews training (ITSO)

CAA (Civil Aviation Authorities – Helicopter)

Advanced Medical Aider (AMA)

HLO

MARLIN’s English Test

Score: 94 %

LTSA LV

IELTS-English TEST

http://www.ielts.org/test_centre_search/search_results.aspx

SCORE

PMS maintenance system – Confirm that you are Familiar with its use (YES / NO)

YES I

DO

YES

YES

YES

YES

DEEP WATER ANCHOR HANDLING EXPERIENCE

ENTER DEPTTH IN METERS

0.3km

DP Maintenance Courses

DP Maintenance Courses

HIGH VOLTAGE COURSE

Dynamic Positioning Induction Course

Dynamic Positioning Simulator Course

Dynamic Positioning Operators CERTIFICATE

Full or Limited

Dynamic Positioning Log book Details

Section 10 Hours done with various DP system

SYSTEM DETAILS

Approx Hours as SDPO / Approx Days in case of Senior ETO / Senior Engineer

Approx Hours as DPO / Approx Days in case of Junior ETO / Junior Engineer

APPROXIMATE Total DP Hours in Various Operations

SAT DIVING

N/A

CABLE LAYING

N/A

AIR DIVING

SURVEY

N/A

ROV

N/A

PIPE LAYING

N/A

WELL STIMULATION / INTERVENTION / ACTIVATION

N/A

DRILL SHIP / SEMI SUB

N/A

AHTS

PSV

N/A

FPSO

N/A

SHUTTLE TANKER

N/A

CONSTRUCTION

ROCK DUMPING / MATTRESSING

CORING

N/A

TRENCHING

HEAVY LIFT

N/A

ACCOMMODATION / GANGWAY

N/A

Page 3 of 7

Section 11 Medical History

YES

NO

Have you ever signed off a ship due medical reason?

NO

Have you undergone any medical operations in past?

NO

Have you consulted a doctor during the past 12 months for an illness / Accident

NO

Do you have any health or disability problem now??

NO

If answer to any of above is YES then give further details below or on a separate sheet

NOTE: All our clients have STRICT Alcohol and Drug Policy, Which means ZERO TOLERENCE for alcohol and drugs

Section 12 General

Yes

No

Have you ever been the subject of a court of enquiry or involved in a maritime accident

NO

Have you ever had a professional licence suspended or revoked

NO

Have you ever been convicted of any criminal offence?

NO

Have you ever been dismissed

NO

If yes to any of above then please full details below or on separate sheet of paper

Section 13 References (Last Two Recent Employers)

Name of company

Royal Wagenborg

Name Person to be contacted

Mike Settels(technical superindendent)

Address

Marktstraat 10 P.O. Box 14 9930 AA Delfzijl The Netherlands

Tel No

[phone]

Fax

[phone]

Email

[e-mail]

Name of company

Norbulk Enterprise Management Srl

Name Person to be contacted

Mr. Ursumando (technical superindendent)

Address

Via Fieschi 8/116121 Genoa Italy

Tel No

+ 39 010 531 9411

Fax

+ 39 010 531 9456

Email

[e-mail]

Section 14 Any other information, you wish to add in support of your application

Section 15 Declaration

I hereby declare that the above particulars are true and I authorize you to contact the referees listed above And confirm that All my certificates / Licences are Authentic / SEASERVICE RECORD is ACCURATE / And I confirm accepting Companies DRUG & ALCOHOL Policy

Signed ………………………… Date…………………..

Page 4 of 7

Section 16 Record of Sea Service (All Dates to be entered as dd/mm/yy)
Please give full record of sea service STARTING FROM LAST VESSEL FIRST
VESSEL	COMPANY	Type of Vessel And Type of operation in case of DP vessels	DWT or GRT (please delete as reqd)	Type of Engines Or DP System	BHP	RANK	Sign on DATE	Sign off DATE
dd / mm / yy dd / mm / yy
"Klaipeda"	LISCO	RO-RO		SKL		ECDT	20.06.05	31.08.05
"Klaipeda"	DFDS-LISCO			SKL		ECDT	24.05.06	01.07.06
"Vilnius"	DFDS-LISCO	RO-PAX		SKL		ECDT	03.07.06	03.12.06
"AFRA"	MARLOW	MPP		BMW		OLR	10.09.07	21.12.07
"LOA"	Peter Dцhle	CNT		MAN BMW		ECDT	14.05.08	29.08.08
"PETROHUE"	Peter Dцhle	CNT		MAN BMW		4th/ENG	16.10.08	17.01.09
"ALHUCEMAS"	CANDINA	RO-PAX		MaK		4th/ENG	23.12.09	23.02.10
"Vilnius"	DFDS-LISCO	RO-PAX		SKL		3^rd/ENG	08.03.09	08.07.09
"MERCIA"	MERIDIAN	RO-RO		MaK		4th/ENG	18.05.10	26.01.10
"FEHNCORAL"	FEHNBEREEDERUNG	Bulk carrier		Deutz		single	04.08.10	25.11.10
"THEKLA"	INTERSEE	Gen. Cargo		MaK		2^nd/En	15.03.11	19.04.11
"Strada Costa"	MERIDIAN	RO-PAX		Pielstick		2^nd/En	18.07.11	21.01.12
"MTS INDUS"	MTS	AHTS(hooper ba)		CaT		Chief/Eng	27.01.12	12.02.2012
"SUNROSE E"	NORBULK	Gen. Cargo		Yanmar		2^nd/En	19.02.2012	22.06.2012
“REESTBORG”	WAGENBORG	Bulk carrier	14.141	Wartsila		2^nd/En	07.07.2013	09.09.2013
Type of Engines:: for engineers only, DPOs to Mark DP System BHP: for Engineers and AHTS / TUG Masters & Officers Page 5 + 6 of 7

	ADDITIONAL INFORMATION SHEET
VESSEL TYPE YOU ARE INTERESTED IN (please list in order of priority)
1.offshore
2.turbine ME
3.electric
4.
5.
MAXIMUM ACCEPTABLE CONTRACT PERIOD (Please indicate below)
2-3 months.
Please Quote –Consolidated MINIMUM MONTHLY SALARY (no leave pay) payable for time onboard only or Working DAY RATE EXPECTATION (no leave pay) (please quote below in US$ -preferred or Euro or GBPЈ)
180EUR/DAY
Languages Spoken / Written / Understood (1-poor 5-Fluent)
	Spoken	Written	Understood
ENGLISH	95%	100%	95%
RUSSIAN	100%	100%	100%
LITHUANIAN	100%	100%	100%
GERMAN	20%	30%	30%
DRUG & ALCOHOL POLICY ALL Our Clients have very strict NO DRUG and ALCOHOL POLICY, Which is required to be complied with at all times, which means “””ZERO TOLERENCE on ALCOHOL & DRUG””” Your body must NOT have any ALCOHOL or DRUG substances from the time you board your flight or commence your travel to join vessel, and Must remain so Until you have completed full contract and returned to your home Airport / Town If during the said period you are found under the influence of DRUG or ALCOHOL then ALL EXPENCES incurred which will include all your travel and recruiting costs, And your relief’s Travel and recruiting costs, And Any other costs whatsoever incurred due to your NON-COMPLIANCE will be deducted from your salary, Which will include but not limited to “damage to vessel her equipments and machineries, loss of charter, and any other costs Directly or indirectly connected with your NON-COMPLIANCE Sign & CONFIRM ACCEPTANCE OF ABOVE POLICY………………………………………
FOLLOWING DOCUMENTS COPIES MUST BE SENT TO US- send to us In separate Email
Licence or Certificate of competency, Any tanker endorsements, GMDSS showing expiry date in case of Deck Officers, Medical Fitness / Examination Certificate, Passport Main page, Seaman book or Discharge book Main pages, In case of DPO – DPO Cert, DP LOG Pages
FOLLOWING ADDITIONAL DOCUMENTS will ALSO BE REQUIRED – Send to us in separate email
All short courses certificates (STCW95), SSO certificate, Last 3-5 years ships entries in Discharge book or Seaman book, Certificate of Equivelant Competency from other flag states

PAGE 7 of 7

Дата добавления: 2015-11-04