Marine MAN
4904105-1210945 PHOTO00 PHOTO Application Form (Engineer) Position: Name: Surname: Date of birth: Place of birth: Permanent address: Mobile : E-mail: Home Phone:Travel Mobile:Skype ID :Overall Size : Parka : Safety Shoes Size :Passport (OVIR) №:: Place of issue:Date of issue:Valid until: Seaman’s book №: Place of issue:Date of issue:Valid until: : Citizenship: Expiry date of Schengen. Visa: Expiry date of U.S. visa: Marital Status: Married Single Divorced WidowerNext of kin: (name, pas. No)Supported children under age of 181. (name, surname, date of birth)2.Knowledge of English language: Very good Good Satisfactory Fair PoorOther language knowledge:Education:Qualification:No Diploma:Date of Issue:College:Academy:Certificates of STCW 78/95No.PlaceDate of issueExpiry dateBasic Safety TrainingProficiency in Survival CraftProficiency in Fast Rescue BoatsAdvanced Fire FightingMedical First AidMedical CareGMDSS CertificateGMDSS EndorsementRadar Observation & PlottingAutomatic Radar Plotting AidsDangerous & Hazardous CargoesHazardous materialsShips Safety OfficerShips Security OfficerIsolating Breathing ApparatusRO-RO Passenger ShipRO-RO ShipOil Tanker FamiliarizationOil Tanker Specialized TrainingGas Tanker FamiliarizationGas Tanker Specialized TrainingChem. Tanker FamiliarizationChem. Tanker Specialized TrainingCrude Oil WashingInert Gas SystemsBridge Resource ManagementVapor Recovery SystemsRefresher & UpdatingMaintenance of Electricaland Electronic EngineeringDesignated Security DutiesAwareness Security TrainingEngine Room Resource ManagementShip Handling Arrangements ISMDP MaintenanceBOSIETHUETSea service (during five last years):Name of vesselCOMPANYDWTFlagTypePositionPeriod of serviceFromTo12345678Automation (A1/A2)Main Eng. Maker/ModelEngine StrokeEngine Total HPAux. Engine Maker/NumberAux. Engine H.P. / KWExperienceUnmannedWithout El.Eng.1/2/3/4/5/6/7/National licenses ,Flag state passports, licenses, visas and other documentsDocument NumberIssuedValidIssued PlaceCERTIFICATE OFCOMPETENCYENDORSEMENTExperience at sea:Knowledge Personal Computer (Yes / No):Medical Certificate №Issued:Place:Exp.date:Vaccination for cholera valid until:Vaccination for yellow fever valid until:Ready to work from: _______________________ Your last salary – Expected salary - Date: ________________ Signature _____________________ ................
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