8.Wife and Children´s ( up to 18) Name | Date of Birth | Passport No. | Date of Issue | Date of Expiry | Place of Issue |
NOT | |||||
NOT | |||||
NOT | |||||
NOT |
12.Seaman´s Book | Number | Date of Issue | Date of Expiry | Country of Issue |
UKRAINE | AB 600020 | ********** | ********** | UKRAINE |
Other |
13.Certificate of Competency | Number | Date of Issue | Date of Expiry | Country of Issue |
ON BASIC TRAINING FOR CARGO OPERATION ON TANKERS | ************8 | ********** | ********** | UKRAINE |
Able seafarer Deck | ************8 | ********** | UKRAINE | |
Flag State Endorsement ( if any) | ||||
MARSHALL ISLANDS | MH538926 | ********** | ********** | LONDON |
14.Courses/Certificates | Number | Date of Issue | Date of Expiry | Place of Issue |
BASIC SAFETY TRAINING | 28102 | ********** | ********** | ADMIRAL |
SECURITY-RELATED FO ALL SEAFARERS | 11505 | ********** | ********** | ADMIRAL |
Proficiency in Survival Craft and Rescue Boats | 23810 | ********** | ********** | ADMIRAL |
Advanced Training in Fire-Fighting | 19611 | ********** | ********** | ADMIRAL |
Medical Emergency-***** Aid | 30403 | ********** | ********** | ADMIRAL |
BASIC TRAINING FOR OIL AND CHEMICAL operation | 3639 | ********** | ********** | ADMIRAL |
Designated security duties for shipboard personnel | 10932 | ********** | ********** | ADMIRAL |
Forklift Operator | 51150 | ********** | ********** | STATE ENTERPRISE |
Radar Observer and Plotting Certificate | ||||
ARPA | ||||
Ship Security Officer | ||||
Ship Safety Officer | ||||
HAZMAT | ||||
Bridge Team and Resource Management | ||||
Ship Handling and Maneuvering | ||||
ECDIS / Electronic charts | ||||
BOSIET / HUET (OPITO) | ||||
Maritime English | ||||
Revalidation course | ||||
Amos-D / Amos-W | ||||
Yellow Fever | FC524749 | ********** | ********** | VACCINATIONE ODESSA CENTR |
Details of any courses/certificates not included in the above to be specified in spare or unutilized columns
I HAVE A GOOD EXPERIENCE OF WORK ON FORKLIFTS
15. PREVIOUS SEA SERVICES (Datewise up to 10 previous vessels ending with last. Experience prior to that to be attached separately).
Name of vessel | Type of vessel | Flag | DWT | Type of Engine | HP | Name of Owners or Managers | Rank | From (day, month, year) | To (day, month, year) |
Captain Glushko | TOW | UKRAINE | 118 | 2X782 KWT | LTD «UDS» | Cadet | ********** | ********** | |
CARINA | BULK CARRIER | MARSHAL ISLAND | 77283 | 11033KWT | SKARLETT SHIPPING LTD | OS | ********** | ********** | |
«SC BEIHAI» | CHEMICAL/OIL PRODUCTS TANKER | Hong Kong | 17777 | 4440 KWT | 6037 | DONGHAI INTERNATIONAL SHIP | OS | ********** | ********** |
GLOSTER-1 | CHEMICAL/OIL PRODUCTS TANKER | COOK ISLANDS | 4595 | 2X640 KWT | PELAGIC CO LTD | AB | ********** | ********** | |
Have you worked with mixed crew before? Yes
Estonians, Latvians, Arabs, Filipinos, Ukrainians,
Russian
17.LANGUAGES (M: Moderate) Spoken Written Read
Vaccination | Date of Vaccination | Date of Expiry | Country of Issue |
Yellow Fewer | ********** | ********** | UKRAINE |
Cholera | |||
Other |
60
58
56
54
52
50
48
46
L
45
44
“___” _______ _______________ _____ _______________________________
Date Signature