I DECLARE WHAT THE ABOVE MENTIONED INFORMATIONS ARE TRUE.AND I HAD NEVER BEEN FIRED FROM ANY COMPANY,OWNER,OR CREWING MANAGERS.

EXPECTED SALARY FROM 2500 TILL 3000 USD

MINIMAL WAGE:2300 USD

READINESS FOR WORK: NOW

PHYSICAL DECLARATION

INTERNATIONAL MEDICAL CERTIFICATE : DATE OF ISSUE: 24 / 11 / 2014 VALID UNTIL DATE: 24 / 11 / 2015 CHOLERA: DATE OF ISSUE: / / VALID UNTIL DATE : / /

YELLOW FEVER:DATE OF ISSUE: 23 / 12 / 2013 VALID UNTIL: 23 / 12 /2023.

VISION: EXCELLENT GOOD POOR

WITHOUT GLASSES:YES

WITH GLASSES:NO

HEARING:GOOD

RIGHT EAR: NORMAL POOR NIL

LEFT EAR:

DID YOU SUFFER,OR DO YOU PRESENTLY SUFFER FROM ANY DESEASE LIKELY TO RENDER YOU UNFIT FOR SERVICES AT SEA OR LIKELY TO ENDANGER THE HEALTH OF OTHER PERSONS ON BOARD ( ) YES ( X ) NO

DID YOU SUFFER ANY ACCIDENT WHICH RENDERED TEMPORARY AND /OR PARTIALLY DISABLED ( ) YES ( X ) NO

DID YOU EVER UNDERGO PSYCHIATRIC TREATMENT ( ) YES ( X ) NO

ARE YOU ADDICTED TO ALCOHOL OR DRUGS OF ANY KIND ( ) YES ( X ) NO

I DECLARE WHAT THE ABOVE MENTIONED INFORMATIONS ARE TRUE.AND I HAD NEVER BEEN FIRED FROM ANY COMPANY,OWNER,OR CREWING MANAGERS.

DATE: FULL NAME:KOROTCHENKOV IGOR

SIGNATURE:

INFORMATION OF M/V RAYNA. THIS CONTRACT WAS INTERRUPTED FROM THE SALES (BEACHING) OF SHIP,ALL CREW IS REPATRIATED.READ INFO IN REFERENCE.

Hereby I certify that the above information is true and accurate to the best of my ability and that no certificate of competence or license issued to me has ever been revoked or suspended. I understand that previous employers may be asked for information concerning my employment record with them and i hereby release from liability or damage those individuals or companies who provide such information.

________________________ _________________________ ____________ _____________

Name Date Signed

Date: 2015-12-18; view: 558