APPLICANT’S PERSONAL DATA __. NAME OF SCHOOL. DOCUMENTS. SERTIFICATE. ISSUED. USA VISA till. SCHENGEN VISA till. Other valid visas . SEA SERVICE FOR LAST 10 YEARS

FIRST/LAST NAME:

POSITION APPLIED FOR:

Photo

FATHER’S NAME:

MARITAL STATUS:

DATE/PLACE OF BIRTH:

NUMBER OF CHILDREN:

E-MAIL/SKYPE:

NEXT OF KIN:

CITIZENSHIP:

RELATION:

ADDRESS:

NEXT KIN ADDRESS:

DATE OF AVAILABILITY:

DESIRED SALARY:

TOTAL SEA SERVICE:             YEAR(S)

IN LAST POSITION:                         CONTRACTS.

PHONE:

MOB:

PHONE:

MOB:

NAME OF SCHOOL

From:

Till:

Type of degree received:

DOCUMENTS

NO.

ISSUED

VALID

CIVIL PASSPORT

SEAMAN’S PASSPORT

TRAVELLING PASSPORT

FLAG STATE DOCS

SERTIFICATE

GRADE

NO.

ISSUED

VALID

NATIONAL LICENSE:

ENDORSEMENT:

GMDSS:

ENDORSEMENT:

BTM/BRM/ERM

SHIP’S HANDLING

RADAR OBSERVER:

ARPA:

ECDIS:

AMOS-W:

SSO/DSD/ASD

ICE NAVIGATION

RISK ASSMT& INCIDENT IVESTIG.

USA VISA till

№                Type

SCHENGEN VISA till

№             Type

Other valid visas 

STCW

№

VALID

№

ADVANCED FIRE FIGHTING: A-VI/3

PROFICIENCY IN SURVIVAL CRAFT & RESCUE BOATS A-VI/2-1:

BASIC TRAINING: A-VI/1-4

MEDICAL FIRST AID: A-VI/4-1

BASIC SSO TRAINING

SPECIAL TRAINING

№

VALID

№

OIL TANKER FAMILIARIZATION:

COW / IGS:

OIL TANKER ADVANCED:

GAS TANKER FAMILIARIZATION:

CHEM. TANKER FAMILIARIZATION:

GAS TANKER ADVANCED:

CHEM. TANKER ADVANCED:

MEDICAL CARE CERTIF. : A-VI/4-2

HEALTH CERTIFICATE:

YELLOW FEVER:

SIZES:     CLOTHES: SHOES: HEIGHT:       WEIGHT:     ENGLISH:      SATISFACT   GOOD EXCELLENT  Malins test__%CES____ %

SEA SERVICE FOR LAST 10 YEARS AT LEAST

COMPANY

FLAG

VSL’S TYPE, teus, pmx, smx, hs, LPG, LNG

DWT

ENGINE

BHP

RANK

DATE

ON

                                                 REFERENCES: TEL, E-MAIL, PERSON`S NAME, COMPANY NAME 

Company name

Person`s name& position 

Phone number

e-mail adress

Data of receiving ref.

Hereby to confirm that all information mentioned in application form is true and my personal data could be used on my behalf for possible employment.

Подачей данной аппликационной формы, подтверждаю свое добровольное согласие на использование моих персональных данных для возможного трудоустройства через компанию  СПБМТК

 SIGNATURE OF SEAMAN:

SIGNATURE OF   CREWING  OFFICER:
Crew Manager, Vladimir Polovinkin _______________ data_________                         data:
M: +7-950-034-68-89

Crew Manager, Vladimir Polovinkin
M: +7-950-034-68-89

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