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Job/Experience/Responsibilities description
APPLICATION FORM
| 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): |
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. | |||
| Email Address: | ||||||
| Names of Children | Sex | Date of Birth | ||||
EDUCATION
| School/Academy name | Country | From | To | Diploma |
| MCTF ONMA | Ukraine | |||
| Seafarers Training Centre | Ukraine |
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 |
ANOTHER SEAMAN'S BOOKS AND LICENSES
| TITLE | NUMBER | ISSUED | VALID | PLACE OF ISSUE |
| Record book | 00649/2014/24 | 02.20.2014 | Odessa | |
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 | |||||
| Endorsement | Second Class Seaman | 10397/2015/07 | 02.23.2015 | port Nikolaev | |
| GMDSS | |||||
| Endorsement | |||||
| Radar navigation-Operation level | 0046/2013 | 02.22.2013 | 02.22.2018 | Odessa | |
| A.R.P.A. | |||||
| Basic safety training | 12.12.2014 | 12.12.2019 | Odessa | ||
| Advanced fire fighting | |||||
| Medical first aid | |||||
| Medical care | |||||
| Prof. in survival craft | 03.18.2014 | 03.18.2019 | Odessa | ||
| Hazardous cargo | |||||
| Dangerous cargo | Petroleum | ||||
| Liquefied Gas | |||||
| Liquid Chemicals | |||||
| Tanker Specific | ADVANCED SAFETY COURSE OIL TANKER | ||||
| ADVANCED SAFETY COURSE CHEM TANKER | |||||
| ADVANCED SAFETY COURSE LPG TANKER | |||||
| Electrical & electronic | |||||
| Ship security officer | 03.18.2014 | 03.18.2019 | Odessa | ||
| Safety officer | 03.18.2014 | 03.18.2019 | Odessa | ||
| Working at Height | |||||
| H2S | |||||
| HUET | |||||
| MIST | |||||
| BOSIET (FOET) | |||||
| DP (……..) | Basic | ||||
| Advanced | |||||
| Full | |||||
| Maintenance | |||||
| Marlin Online Test |
MEDICAL EXAMINATION / HISTORY
| Number | Issued | Valid | Place of issue | |
| Medical Examination | 09.23.2014 | 09.23.2015 | Odessa | |
| Physical Examination | 09.23.2014 | 09.23.2015 | Odessa | |
| Yellow Fever | AB495976 | 09.23.2014 | 09.23.2024 | Odessa |
| OGUK |
| Medical history (mark Bold) | ||
| Have you ever signed off a ship due to medical reasons? | NO | |
| Have you undergone any operation in the past? | NO | |
| Have you consulted a doctor during the last 12 months for an illness/accident? | NO | |
| Do you have any health or disability problems now? | 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 | 15kBt | cadet | Solex | 07.01.2010 | 07.21.2010 | |
| Genuya | Passanger | Ukr | 82p.t | 440kBt | cadet | Solex | 07.14.2011 | 08.30.2011 | |
| Reid 8 | Passanger | Ukr | 120p.t | 720kBt | OS | IMTP | 05.24.2012 | 11.24.2012 | |
| Sevastopol | Passenger | Ukr | 126p.t | 440kBt | OS | Arovana-Tur | 10.10.2014 | 12.09.2014 | |
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 |
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 |
Job/Experience/Responsibilities description
| General (mark Bold) | ||
| Have you ever been the subject of a court of enquiry or involved in a maritime accident? | NO | |
| Have you ever had a professional license suspended or revoked? | 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) | |
| Safety Shoe size |
Date: 2016-01-14; view: 1327
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