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APPLICATION FORM
|
First name: |
Oleksandr |
Middle name: |
Oleksandrovich |
Surname: |
Nikolov |
|
Date of birth: |
30.06.1989 |
Rank: |
motormen |
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|
Children under 18: |
none |
Position applied for: |
|||
|
Nationality: |
Ukraine |
Readiness: |
|||
|
Present Address: |
Street: |
Izmail. Suvorova str.321 |
English language: |
Fluent |
Very Good |
|
+Good |
Satisfied |
||||
|
Tel.: |
+380679926061 |
Salary desired: |
CERTIFICATE CHECK LIST
|
Certificate of STCW – 78/95 OFFICERS |
Number |
Issued |
Expired |
Place of issue |
|
|
Travel Passport |
ET 593916 |
04.01.2012 |
04.01.2022 |
Izmail |
|
|
Seaman’s Book |
AB 464271 |
23.07.2012 |
23.07.2017 |
Imail |
|
|
Certificate of competency |
00239/2012/01 |
30.08.2012 |
Izmail |
||
|
Endorsement of certificates of competency |
00239/2012/01 |
30.08.2012 |
31.12.2016 |
Izmail |
|
|
Personal Survival techniques |
A-VI/1-1,2.3,4 |
7301/MPS |
13.04.2012 |
13.04.2017 |
Izmail |
|
Proficiency in survival craft |
A-VI/2/1-4 |
6053/MPS |
09.04.2012 |
09.04.2017 |
Izmail |
|
Chemical Tankers Specialized |
A-VI/1 |
||||
|
Tanker Familiarization |
A-V/1 |
||||
|
Serving Onpassenger/ro-ro passenger |
A-V/3 |
2402/MPS |
26.04.2012 |
31.12.2016 |
Izmail |
|
Advanced Fire fighting |
A-VI/3 |
||||
|
Medical First Aid on Board |
A-VI/4 |
||||
|
Oil Tankers Specialized |
A-V/1 |
||||
|
Liquefied Gas Tankers |
A-V/1 |
||||
|
Personnel serving Ro-Ro Passenger |
A-V/2 |
11847/MPS |
24.04.2012 |
24.04.2017 |
Izmail |
USA Visa : none
PREVIOUS SEA SERVICE (LAST 5 YEARS)
|
Vessel’s name |
Type |
Engine |
HP/KWT |
Rank |
From |
To |
Owner |
|
m/v Alice |
cargo |
Г70 |
2x1200h.p.(2x883kwt) |
motorman |
28.02.2013 |
16.09.2013 |
Cambodia |
|
Vaccination valid until |
Yellow fever: |
Issued: |
Cholera: |
||||
|
Height: |
182 |
Weight: |
82 |
Clothing: |
XXL |
Footwear: |
43 |
Date: _______________________________ Signature: ____________________________