SEAMAN’S APPLICATION FORM

SEAMAN’S APPLICATION FORM

MARINE CENTRE

POSITION APPLIED FOR
SURNAME	Bublii	MARITAL STATUS
FIRST NAME	Sergii	NAME OF WIFE
MIDDLE NAME	Vladimirovich	NEXT OF KIN
DATE OF BIRTH	07.09.1987	RELATION	Sister
PLACE OF BIIRTH	Ukraine	PHONE
ADDRESS	Yuzhny.st.Lenina 16/24	ADDRESS
HOME PHONE	2-52-57	CHILDREN
MOB PHONE	0931098618.0932416050	NAME
CITIZENSHIP	Ukraine
NAME OF SCHOOL		ENGLISH LEVEL
FROM / TILL			CLOSIEST AIRPORT	Odessa
TYPE OF DEGREE

NATIONAL DOCUMENTS	NO.	ISSUED	VALID
SEAMAN’S PASSPORT	AB 436469	11.03.2010	11.03.2015
TRAVELLING PASSPORT	EE 115326	03.06.2008	03.06.2018
OTHER PASSPORT	COUNTRY	KM 187836	16.12.2003

USA VISA	NO.	ISSUED	VALID
PLACE OF ISSUE

NATIONAL LICENSE	GRADE	NO	ISSUED	VALID
CERTIFICATE OF COMPETENCY		00225/2010/08	03.03.2010
ENDORSEMENT		00225/2010/08	03.03.2010	07.05.2013
GMDSS
ENDORSEMENT

CERTIFICATES	NO	ISSUED	VALID
BASIC SAFETY STCW 95	2/2454/08	07.05.2008	07.05.2013
ADVANCED FIRE FIGHTING	0173/2011	16.02.2011	16.02.2016
HAZARDOUS CARGO
MEDICAL FIRST AID		CARE
SURV CRAFT&RESCUE BOATS	0265/2011	16.02.2011	16.02.2016
SPECIALIZED TANKER TRAINING
TANKER FAMILIRIZATION
PETROLEUM TANKER SAFETY
COW+IGS
CHEM.TANKER SAFETY
SPECIALIZED GAS TA TRANING
BRIDGE TEAM MANAGEMENT
SHIP’S HANDLING
RADAR OBSERVER
ARPA
SHIP SECURITY OFFICER
INTRODUCTION TO ISM

HEALTH CERTIFICATE		YELLOW FEVER		COLOR OF HAIR
HEIGHT		WEIGHT		COLOR OF EYES

PREVIOUS SEA SERVICE

Vessel’s Name	TYPE	DWT	ENGINE	FLAG	RANK	S.ON	S.OFF	COMPANY

Дата добавления: 2015-11-04