Ukraine, Kherson
23 Gorkogo str.
Phone/Fax: +380552 454800
Mobile :+380504944082
Mobile :+380675530989
Mobile :+380939750392
E-mail: cv@marineman.ua
PHOTO
Application Form (El. Engineer)
Name:
Surname:
Date of birth:
Place of birth:
Permanent address:
Mobile :
Home Phone:
Travel Mobile:
Overall Size :
Parka :
Passport (OVIR) №::
Place of issue:
Seaman’s book №:
Place of issue:
Citizenship:
Expiry date of Schengen. Visa:
Marital Status:
Married
Single
Next of kin: (name, pas. No)
Supported children under age of 18
1.
(name, surname, date of birth)
2.
Knowledge of English language:
Very good
Good
Other language knowledge:
Education:
College:
Academy:
Certificates of STCW 78/95
Basic Safety Training
Proficiency in Survival Craft
Proficiency in Fast Rescue Boats
Advanced Fire Fighting
Medical First Aid
Medical Care
GMDSS Certificate
GMDSS Endorsement
Radar Observation & Plotting
Automatic Radar Plotting Aids
Dangerous & Hazardous Cargoes
Hazardous materials
Ships Safety Officer
Ships Security Officer
Isolating Breathing Apparatus
RO-RO Passenger Ship
RO-RO Ship
Oil Tanker Familiarization
Oil Tanker Specialized Training
Gas Tanker Familiarization
Gas Tanker Specialized Training
Chem. Tanker Familiarization
Chem. Tanker Specialized Training
Crude Oil Washing
E-mail:
Skype ID :
Safety Shoes Size :
Date of issue:
Valid until:
Date of issue:
Valid until: :
Expiry date of U.S. visa:
Divorced
Widower
Satisfactory
Qualification
No.
Fair
No Diploma
Place
Date of issue
Poor
Date of Issue
Expiry date
Inert Gas Systems
Bridge Resource Management
Vapor Recovery Systems
Refresher & Updating
Maintenance of Electrical
and Electronic Engineering
Designated Security Duties
Awareness Security Training
Engine Room Resource Management
Ship Handling Arrangements
ISM
DP Maintenance
BOSIET
HUET
Sea service (during five last years):
Name of vessel
COMPANY
DWT
Flag
Type
Position
Period of service
From
To
1
2
3
4
5
6
7
8
Main Engine Maker
Main Engine Aux.Engine
Total H.P.
Maker/
Number’s
Aux.Engine
H.P./kW
Voltage
(220/380/
440)
Automation
class
(A1/A2)
Automation
Systems
Maker
Crane/Maker/
Type/SWL
Derrick/Maker
Type/SWL
1
2
3
4
5
6
7
8
National licenses ,Flag state passports, licenses, visas and other documents
Document
Number
Issued
Valid
Issued Place
CERTIFICATE OFCOMPETENCY
ENDORSEMENT
Experience at sea:
Medical Certificate №
Vaccination for cholera valid until:
Knowledge Personal Computer (Yes / No):
Issued:
Place:
Exp.date:
Vaccination for yellow fever valid until:
Ready to work from: _______________________
Your last salary –
Expected salary Date: ________________
Signature _____________________
2