Job/Experience/Responsibilities descriptionAPPLICATION FORM
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| FULL NAME:
| Yesariev Kostiantyn
| | RANK:
| OS/Messboy
| | HOME ADDRESS:
| str.Ac.Coroleva 72/ Odessa/ Ukraine
| | MOBILE PHONE:
| 063 128 77 67
| | E-MAIL:
| iamsai70r@gmail.com
| | SKYPE NAME:
| esarev92
| | NATIONALITY:
| Ukraine
| | DATE OF BIRTH:
| 06.22.1992
| | PLACE OF BIRTH:
| Odessa/Ukraine
| | SPOKEN ENGLISH (0-10):
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NEXT OF KIN
| Full Name:
| Skripka Anastasiya
| | Address:
| str. Novgorodskaya 6v
| | Date of Birth
| 08.06.1992
| | Contact telephone numbers:
| 1st.
| 093-286-52-69
| 2nd.
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| | Email Address:
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| | Names of Children
| Sex
| Date of Birth
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EDUCATION
| School/Academy name
| Country
| From
| To
| Diploma
| | MCTF ONMA
| Ukraine
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| | Seafarers Training Centre
| Ukraine
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PASSPORTS/VISA
(Please, fill up details of passports and visa, if have more add into new rows)
| TITLE
| NUMBER
| ISSUED
| VALID
| PLACE OF ISSUE
| | Seaman's Book
| ab495976
| 05.30.2012
| 05.30.2017
| port Nikolaev
| | Travel passport
| er298684
| 03.14.2014
| 93.14.2024
| Passport centre Authority 5112
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ANOTHER SEAMAN'S BOOKS AND LICENSES
| TITLE
| NUMBER
| ISSUED
| VALID
| PLACE OF ISSUE
| | Record book
| 00649/2014/24
| 02.20.2014
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| Odessa
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CERTIFICATES AND OTHER DOCUMENTS
(Please, fill up details of certificates, documents, tranings, tests, if have more add into new rows)
| TITLE
| CLASS/TYPE/RESULT
| NUMBER
| ISSUED
| VALID
| PLACE OF ISSUE
| | COC
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| | Endorsement
| Second Class Seaman
| 10397/2015/07
| 02.23.2015
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| port Nikolaev
| | GMDSS
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| | Endorsement
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| | Radar navigation-Operation level
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| 0046/2013
| 02.22.2013
| 02.22.2018
| Odessa
| | A.R.P.A.
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| | Basic safety training
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| 12.12.2014
| 12.12.2019
| Odessa
| | Advanced fire fighting
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| | Medical first aid
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| | Medical care
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| | Prof. in survival craft
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| 03.18.2014
| 03.18.2019
| Odessa
| | Hazardous cargo
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| | Dangerous cargo
| Petroleum
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| | Liquefied Gas
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| | Liquid Chemicals
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| | Tanker Specific
| ADVANCED SAFETY COURSE OIL TANKER
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| | ADVANCED SAFETY COURSE CHEM TANKER
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| | ADVANCED SAFETY COURSE LPG TANKER
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| | Electrical & electronic
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| | Ship security officer
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| 03.18.2014
| 03.18.2019
| Odessa
| | Safety officer
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| 03.18.2014
| 03.18.2019
| Odessa
| | Working at Height
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| | H2S
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| | HUET
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| | MIST
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| | BOSIET (FOET)
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| | DP (……..)
| Basic
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| | Advanced
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| | Full
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| | Maintenance
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| | Marlin Online Test
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MEDICAL EXAMINATION / HISTORY
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| Number
| Issued
| Valid
| Place of issue
| | Medical Examination
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| 09.23.2014
| 09.23.2015
| Odessa
| | Physical Examination
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| 09.23.2014
| 09.23.2015
| Odessa
| | Yellow Fever
| AB495976
| 09.23.2014
| 09.23.2024
| Odessa
| | OGUK
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| | Medical history (mark Bold)
| | Have you ever signed off a ship due to medical reasons?
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| NO
| | Have you undergone any operation in the past?
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| NO
| | Have you consulted a doctor during the last 12 months for an illness/accident?
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| NO
| | Do you have any health or disability problems now?
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| NO
| PREVIOUS SEAGOING EXPERIENCE (last 5 years)
(Please, fill up details of sea service experience, if have more add into new rows)
| NAME
| M/V TYPE
| FLAG
| GT/DWT
| ENGINE
| BHP/KW
| RANK
| COMPANY
| FROM
| TO
| | Valensiya
| Passanger
| Ukr
| 82p.t
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| 15kBt
| cadet
| Solex
| 07.01.2010
| 07.21.2010
| | Genuya
| Passanger
| Ukr
| 82p.t
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| 440kBt
| cadet
| Solex
| 07.14.2011
| 08.30.2011
| | Reid 8
| Passanger
| Ukr
| 120p.t
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| 720kBt
| OS
| IMTP
| 05.24.2012
| 11.24.2012
| | Sevastopol
| Passenger
| Ukr
| 126p.t
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| 440kBt
| OS
| Arovana-Tur
| 10.10.2014
| 12.09.2014
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Offshore experience
(Please, fill up details of offshore experince, if have more add into new rows)
| Ship name
| Owner
| Project name (Client name) / Aria of operation
| Project description
| Date
from – to
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Dry-docking experience
(Please, fill up details of dry-docking experince, if have more add into new rows)
| Ship name
| Owner
| Dry-dock place
| Description of dry-docking
| Date
from – to
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Job/Experience/Responsibilities description
| General (mark Bold)
| | Have you ever been the subject of a court of enquiry or involved in a maritime accident?
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| NO
| | Have you ever had a professional license suspended or revoked?
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| NO
| (If YES, please give full details and attach a separate page if necessary)
WORKING GEAR
| Boiler Suit Size(9 S/M/L/XL/XXL)
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| | Safety Shoe size
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Date: 2016-01-14; view: 1113
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