Вахтенный помощник капитана
Андрей
Возраст
42 года (11 Января 1983)
Город
Анадырь
Описание
Country of Issue USA Visa - Type B1/OCS
Date Issued USA VISA Expires
Place Issued RUSSIA,ANAPA USA Visa - Type C1/D
Passport Number 753237313 USA VISA Expires
Passport –Expires 27.05.2026 Other Country Visa
Secondary passport or Dual nationality UKRAINE Visa Expiry
Section 4 ( hi-light as required ) Seaman book / Discharge book / Seaman Record Book / CDC
Issuing Country & Place RUSSIA,NOVOROSSIYSK Date Issued 12.08.2016
Number 0043296 Expiry Date (if any) 11.08.2021
Section 5 Next of Kin – this is important information we require- Don’t ignore it
Full Name / Relationship BILAYA NINA mother
Any dependents / Children (incl age )
Address
Contact Numbers +79780748101
Section 6 STCW2010 (STCW78, as amended) Highest Certificate of Competency / Licence Held
Class / Grade/Capacity STCW ISSUING COUNTRY CERTIFICATE No DATE ISSUED EXPIRY
CODE
Navigational watch Rating Russia 10070 05.12.2016 Non
OOW Russia 92009 05.12.2016 22.06.2021
ALSO ENTER ABOVE DETAILS OF ANY OTHER FLAG STATE CERTIFICATES HELD
Section 7 CRANE OPERATORS CERTIFICATES
Or Other Equivelent Certificates- Give Full details incl Country of issue Certificate No Issue Date Expiry if any
VERITAS stage 1 K/B UKRAINE 190402014 28.11.2014 27.11.2018
GMDSS GOC Russia 1012862 05.12.2016 non
Section 8 STCW2010 (STCW78, as amended) related Courses Attended and Certificates Obtained
Name of Course / Certificate STCW Code Place Issue Date Cert No Expiry Date
GMDSS Endorsement Russia 05.12.2016 2012408557 22.06.2021
ECDIS Generic Astrachan 23.09.2016 592299 23.09.2021
ARPA A-VI/1-2 Astrachan 07.10.2016 592059 07.10.2021
Basic Safety training A-VI/1-3 Astrachan 23.08.206 592700 23.08.2021
Medical Care A-VI/ 1-4 Astrachan 25.09.2014 Odessa 25.09.2019
Proficiency in Survival Craft & Rescue Boats A-VI/ 2-1 Astrachan 01.09.2016 0593199 01.09.2021
ECDIS Type specific Astrachan 23.09.2016 592299 23.09.2021
Proficiency in FAST RESCUE BOATS A-VI/ 2 Odessa 01.10.2014 0399298 01.10.2019
Advanced Fire Fighting A-VI/ 3 Odessa 05.12.2014 18998 05.12.2019
Medical & First Aid A-VI/ 4-1 Odessa 25.09.2014 186325 25.09.2019
Ship Security Officers Course (SSO) A-VI/ 5 Astrachan 27.08.2016 593767 27.08.2021
Issued under STCW2010
RADAR OBSERVATION AND PLOTTING A-VI/6 Russia 30.09.2016 591881 30.09.2021
Proficiency in Designated Security Duties A-VI Odessa 12.03.2014 7429 12.03.2019
Medical Certificate / HEALTH Certificate STCW2010 / MLC Sevastopol 22.06.2017
Compliant
BRIDGE TEAM In progress
Blood Group Information Type 1+ RH
YELLOW FEVER ROSTOV on DON 24.04.2007 24.04.2017
MARLIN’s English Test
IELTS-English TEST http://www.ielts.org/test_centre_search/search_results.aspx SCORE
Section 9 OFFSHORE INDUSTRY COURSES
BANKSMAN
SLINGER
CRANE MAINTENANCE
Boatman Certificate
BOSIET
H2S Qatar,Doha 17.12.2014 1011214b9458 17.12.2016
HUET Qatar,Doha 17.12.2014 1011214b9464 17.12.2017
OFFSHORE MEDICALS
( UK, NORWAY or NETHERLAND )
Re-Breather training
Page 2 of 7
Section 9 OFFSHORE INDUSTRY COURSES- CONTINUED
Please enter below any other certificates held or courses done, ie offshore, DP certs etc or Any other not already mentioned
Name of Course / Certificate APPROVALS Place Issue Date Cert No Expiry
CAA (Civil Aviation Authorities – Helicopter)
Advanced Medical Aider ( AMA )
HLO
HLA
Helicopter Refuelling
Hydrogen Sulphide (H2S)
SHALLOW WATER AIR DIVING SUPPORT ENTER DEPTTH IN METERS 10 METERS
1. Have you ever signed off a ship due medical reason and been hospitalised? No
2. Have you ever been signed off the vessel and repatriated due illness? No
3. Have you undergone any medical operations in past? No
4. Have you consulted a doctor during the past 12 months for an illness / Accident No
5. Do you have any health or disability problem now?? No
6. Any Past Medical Condition – Which May Affect Your Work :- (If Yes Than Please Specify Below) no
7. Do you feel healthy and fit to perform the duties of your designated position/occupation? Yes
8. Are you allergic to any medications?- If Yes, then please identify below no
Allergic to Medications :
9. Are you taking any non-prescription or prescription medications at present? no
If yes, please list the medications taken, and the purpose(s) and dosage(s):
PRESCRIPTION MEDICATION:
NON-PRESCRIPTION MEDICATION:
If answer to any of above is YES then give further details below or on a separate sheet
NOTE : All our clients have STRICT Alcohol and Drug Policy,
Which means ZERO TOLERENCE for alcohol and drugs
Yes No
Have you ever been involved in a maritime accident, ie grounding, fire, Explosion, Collision, etc No
Have you ever been the subject of a court of enquiry or involved in a maritime accident No
Have you ever had a professional licence suspended or revoked No
Have you ever been convicted of any criminal offence? No
Have you ever been dismissed no
If yes to any of above then please full details below or on separate sheet of paper
Section 12 PROVIDE DETAILS OF YOUR LAST TWO EMPLOYERS, IN
4 января, 2018
Федор
Город
Анадырь
Возраст
33 года ( 1 февраля 1992)
10 сентября, 2017
Юрий
Город
Анадырь
Возраст
42 года ( 1 марта 1983)
25 сентября, 2017
Павел
Город
Анадырь
Возраст
36 лет (21 декабря 1988)