SEAFARER’S APPLICATION FORM. 1ST CHOICE: 2nd ENG. 2ND CHOICE: 3rd ENG. Surname: Kupreyev. First Name: Viktor. Middle Name: Viktorovych. Date of birth: 19.06.1989. Place of birth: AR Crimea. Permanent address: Heroes of Stalingrada. Nationality: Russian. N

SEAFARER’S APPLICATION FORM

1ST CHOICE: 2nd ENG					2ND CHOICE: 3rd ENG				Место для фото
Surname: Kupreyev		First Name: Viktor					Middle Name: Viktorovych
Date of birth: 19. 06. 1989		Place of birth: AR Crimea					Min. Wage:
Permanent address: Heroes of Stalingrada						Nationality: Russian
Nearest Airport: Simferopol: Kherson						E-mail: Vityambergz2014@gamil. com
Phone(Home): 7-61-30				Phone(Mob. ): +7978-798-27-61				SKYPE: vite4ek12345
Marital Status (Married, Single, Divorced): Married						Next of Kin (Name / Relation): Anna/wife
Address Next of Kin: 2nd 5-th ears street 6 app. 3
Nbr of Children: Alexender			Colour of Eyes: blue				Colour of Hair: light
Height: 183___cm	Weight: 86____Kg				Overall Size:			Shoes Size: 43

Knowledge of English (fluent/good/moderate/poor): moderate

Other languages:

LICENSES & CERTIFICATES	№	Date of Issue	Expiry Date	Place of Issue
Certificate Of Competency( )		02. 06. 2017	21. 10. 2021	Russia
Endorsement Of Certificate
Seaman’s Passport		27. 07. 2015	26. 07. 2020	Russia
Travel Passport	73 7229082	24. 02. 20. 15	24. 02. 2025	Russia
Basic Safety	AB 0763126	21. 03. 2017	21. 03. 2022	Russia
Proficiency in Survival Craft & Rescue Boats	AB 0763763	25. 03. 2017	25. 03. 2022	Russia
Advanced Fire Fighting	AB 0763479	14. 03. 2017	14. 032022	Russia
Med. First Aid / Care	AB 0763928	17. 03. 2017	17. 03. 2022	Russia
GMDSS
RADAR / ARPA
HAZMAT
Security Officer (ISPS Code)	AB 0497705	23. 030. 2017	23. 03. 2022	Russia
Tanker (Basic oil chemical/ Spesialized)	AB 0217621 / KR 1761301	18. 09. 2015 / 31. 032022	18. 09. 2020 / 31. 03. 2022	Russia / Russia
Ro-Ro Passenger Ships
USA VISA, PANAMA, LIBERIA and other

Last Med. Exam. (Till): 04.. 03. 2018 Blood group: B ( ) Ph+ Yellow Fever (Till): 09. 06. 2018 Graduated from: Spicialist Year: 26. 02. 2013 DETAILS OF PREVIOUS SEA SERVICE
RANK	COMPANY	NAME OF VSL	FLAG OF VSL	TYPE OF VSL	TYPE OF ENGINE	DWT	BHP	FROM	TO
3^rd eng	Arida Trade	Goeast	Comovos	Oil Product tanker	Hitachi B& W 6K4SGF			11, 10, 2015	11, 06, 2016
2^nd eng	Uvas trans	Ant	Russia	G. C.	MAN B& W diesel			20. 06. 2016	17. 02. 2017
2^nd eng	Нефтегаз мор-сервис	Кристал	Russia	Oil product tanker	8NVD48 A-2u			19. 022017	01. 062017
Ch. eng	Нефтегаз мор-сервис	Rondo	Russia	Bunker	6чн 18/22			01, 06, 2017	31, 01, 2018

I HEREBY CERTIFY THAT ALL THE INFO CONTAINED HERE IN IS TRUE & CORRECT ANY MISREPRESENTATION WILL BE SUFFICIENT GROUND FOR DISQUALIFICATION & / OR ISMISSAL

Cогласен на обработку моих персональных данных

Date: 06. 02. 2018 Signature:

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