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Address/Telephones. Documents and certificates. Date of issue. Sea Service during last five years (count backwards). Vessel’s. Main engine. Ship-owner/ManagerСтр 1 из 5Следующая ⇒
Personal particulars
Name of father:___ Nicholas __________ Name of mother:____ Natalia _________ Name of spouse:__---___ Children under 18 (name/date of birth):__________________-----_______________________________________________ Home address: Dobrovolskogo 126 ap 212 Telephones: 0938792280 7114998 Next of Kin: Surname____Ivcenko____Name_____ Natalia______ Relationship____0930177108___ Address/Telephones The same Dobrovolskogo 126 ap 212 E-mail: Sashau4@breezein.net Documents and certificates
Date of issue | Valid until | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Seaman’s passport | AB 529930 | Illichivsk | 06.05.2014 | 06.05.2019 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Civil travel passport | EX832353 | Odessa | 05.12.2013 | 05.12.2023 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Civil passport | KM596766 | Odessa | 06.05.2009 | ID № KM596766 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Certificates of Competency | Grade | No | Place of issue | Date of issue | Endorsement valid until |
National | motorman | 10122/2014/01 | Izmail | 18.03.2014 | |
Name of Marine School (Academy):_____________________________________________________ Graduated on _______
STCW Certificates | No | Date of issue | Valid until |
Basic safety/survival at sea | 16589/2012/AT Izmail | 04.12.2012 | 04.12.2017 |
GMDSS | |||
ROPS, ARPA | |||
Advanced fire-fighting | |||
Proficiency in survival craft | 3500/2014-A Illichivsk | 25.02.2014 | 25.02.2019 |
Basic training for oil and chemical cargo | 3577/2013-A Illichivsk | 22.11.2013 | 22.11.2018 |
Dangerous cargo (Hazmat) | |||
Security officer | |||
Safety officer | |||
Yellow fever | |||
US VISA |
Sea Service during last five years (count backwards)
Rank
Vessel’s
Main engine
Ship-owner/Manager
From
(mm.yy)
To(mm.yy)
Name Flag Type DWT Type HP motorman PATRIOT UKR Tug Diesel 3000 KvM Ltd Tecom leasing 04.04 21.06 seaman PATRIOT UKR Tug Diesel 3000 KvM Ltd Tecom leasing 01.09 31.10Наличие справок о плавании и отзывов о работе приветствуется
Notes:
Signature ______Ivchenko_______________________ Date 14.05.2014
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