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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


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