| ADDITIONAL INFORMATION
Kaliningrad
-----------------------------------------------------------------------------------------------------------------------------
Moskovskiy Avenue, Office 805, Kaliningrad 236006, Russia
Tel: +7 4012 999 970, +7 4012 999 980 Fax: +7 4012 537165
E-mail: ru-csc-kgd-staff@bs-shipmanagement.com
APPLICATION FORM / PERSONAL DATA
| Family Name:
| Name:
| | Father?s Name:
| Mother?s Name:
| Wife?s Maiden Name:
| | Date of Birth:
| Place of Birth / City & Country:
| Citizenship:
| | Height:
| Weight:
| Colour of eyes:
| Colour of hair:
| | Permanent address:
| Phone (home):
| | | Phone (business):
| | | e-mail:
Skype ID:
|  married
 single
 divorced
| Wedding date:
| Next of kin (name, surname, kinship):
| Address next of kin:
| | Date of birth (next of kin):
| Phone:
| Nearest airport:
| | Religion:
| Waist: (cm)
| Chest: (cm)
| Shoe size:
| Collar: (cm)
| | | | | | | | | | | | | | |
POSITION APPLIED FOR:
| DOCUMENTS
| NUMBER
| ISSUED
| VALID
| CITY OF ISSUE
| | TRAVEL PASSPORT
| | | | | | ID CARD
| | | | | | LICENSE _______________ (GRADE)
| | | | | | ENDORSEMENT_________(GRADE)
| | | | | | TANKERMAN FAMILIARIZATION COURSE V/1
| | | | | | TANKERMAN HIGHEST GRADE CERTIFICATE
| LPG
| | | | | | OIL
| | | | | | CHEM
| | | | | | COW (Crude Oil Washing)
| | | | | | Training of Seafarers with Designated Security Duties
| | | | | | Basic safety training
| | | | | | Proficiency in Survival Craft & Rescue Boats
| | | | | | Advanced Training Fire FightingA-VI/3
| | | | | | Designated security duties A-VI/6-2
| | | | | | GMDSS
| | | | | | RADAR OBS
| | | | | | ARPA
| | | | | | MEDICAL CAREA-VI/4-2
| | | | | | MEDICAL FIRST AIDA-VI/4-1
| | | | | | YELLOW FEVER VACCINATION
| | | | | | HEALTH CERTIFICATE
| | | | | | VISA SCHENGEN
| | | | | | USA VISAC1/D
| | | | | | OTHER SEAMAN? S BOOK
| | | | | | OTHERS DOCUMENTS
| | | | | | | | | | | | | | | | | | | | |
SEA SERVICE:
FOUR TOP OFFICERS LAST 10 YEARSRATING, JUNIOR OFFICERS LAST 5 YEARS
| TYPE OF
VESSEL
| NAME OF
VESSEL
| DWT
| ENG. TYPE
| KW
| FLAG
| NAME OF
COMPANY
| RANK
| PERIOD OF SERVICE
FROM / TO
dd/mm/yy / dd/mm/yy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | EDUCATION:
| Maritime School:
Maritime College:
Maritime Academy:
| FROM:
| | TO:
|
| | | | | ENGLISH:
| GOOD
| SATISFACTORY
| MODERATE
| POOR
| | | | | | REFERENCES (COMPANY, TEL. No.):
| | | | |
| | | | | | | | | |
ADDITIONAL INFORMATION
FOR TOP FOUR OFFICERS (MASTER, CH/OFF, CH/ENG, 2/ENG)
| NEW BUILDINGS EXPERIENCE (NAME OF THE VSL, YEAR, SHIPYARD):
| | | | | |
| SHIPYARD EXPERIENCE (VESSEL?S NAME, PLACE, YEAR)
| | | | | |
| | | PC KNOWELEDGE (SYSTEMS, PROGRAMS)
| | | | | |
| | | OTHER SPECIAL EXPERIENCE
| | | | | |
| | |
NOTES:
| | | | | | | | DATE: SIGN:
Date: 2016-06-12; view: 214
|
