Матрос обработчик на МРКТ и БМРТ

Описание

Position apply for
Type of Vessel PERSONAL DETAILS
Surname
ФамилияDate of birth
First Name ИмяCitizenship
Middle Name ОтчествоGender
Place of birth Место рождения Civil status
Religion PERMANENT ADDRESS
Street
Улица
House Flat
Comments
City
Country Регион
Airport Post codeREGISTRATION ADDRESS
Street
Улица
House FlatComments
City
Country РегионCONTACT DETAILS
Primary Mobile Number
Secondary Mobile Number
Home Phone E-mailNE;T OF KIN / BENEFICIARY
Surname
First nameMiddle name
Birthdate Gender
Street Relation
House Flat
Mobile
City Phone (Home)
Country E-mailLIST OF CHILDREN (UP TO 21 AGE)
Surname
First nameMiddle name
Relation Birthdate
Gender
Surname First nameMiddle name
Relation Birthdate
Gender
Surname First nameMiddle name
Relation Birthdate GenderPHYSICAL DETAILS
Height
cm Hair colour Uniform size
Weight kg Eyes colour Shoes size
Comments / Комментарий $PP/,C$7,21 )250
/askLn
Eаскин//PaJe
2rdLnary 6eaman 2,/ 7$1.(5 PhotoPlease let us know how you heard about our company / Как Вы о нас узнали?
Iо рекомен^аpии знакомыo
Daniil ДаниилRUSSIAN FEDERATION
Vladimirovich ВладимировичMALE
SAINT PETERSBURG Мурино/Murino
Russia, Leningrad region, Vyborg
Воронцовский бульвар 16к2
16k2 37 Christian
Vorontsovsky boulevfrd Россия, Ленинградская обл., Выборг
Single
LED Pulkovo 188687
RUSSIAN FEDERATION
Ленинградская область
15 29
VIBORG
RUSSIAN FEDERATION Ленинградская область
+7 931 578-12-97 Вещево/Veshchevo
danilkalaskin@mail.ru Laskina
Viktoria Yuryevna
3/29/1984 FEMALE
garden street Mother
24 +79217653159
VIBORG
RUSSIAN FEDERATION
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167
BLACK
48
60 BROWN
40

NATIONAL IDENTITY DOCUMENTS / VISA
Civil Passport Series No Issued
Authority
Foreign Passport Series No IssuedExpiry
Authority
Seafarer's ID Series No IssuedExpiry
Authority
Seaman's Book Series No Issued
Authority
USA VISA IssuedExpiry
Visa Type Issuing Post Name
Shengen VISA IssuedExpiry
No. of Visa Issuing Post Name
EDUCATION
CERTIFICATE OF COMPETENCE NATIONAL DOCUMENTS (ENDORSMENTS)
TRAINING COURSES APPLICATION FORM
1/28/2030Basic Training for oil and chemical tanker cargo operation Admiral Makarov State University of Maritime and Inland Shipping, Training Centre
00878/255/14/20255/14/2030
GMDSS GOC Training
Admiral Makarov State University of Maritime and Inland Shipping, Training Centre
5394/251/28/2025 2/6/2030
Medical First Aid Admiral Makarov State University of Maritime and Inland Shipping, Training Centre
06787/252/14/20252/14/2030
ECDIS Generic Course
Admiral Makarov State University of Maritime and Inland Shipping, Training Centre
02469/252/6/202512/16/2027Security Training for Seafarers with designated security duties Admiral Makarov State University of Maritime and Inland Shipping, Training Centre
04341/233/7/20233/7/2028
Basic Safety Training
Admiral Makarov State University of Maritime and Inland Shipping, Training Centre
04985/2212/16/2022
TYPE
INSTITUTENUMBERPERIOD
ISSUED EXPIRY
TYPE
AUTHORITYNUMBERPERIOD
ISSUED EXPIRY
Rating forming part of Nav Watch
Harbour Master - Big port Saint Petersburg
LED2088425794/21/2025
TYPE
INSTITUTENUMBERPERIOD
ISSUED EXPIRY
Issued On
FROM TO
Technical College4/21/2025
NAME OF (MARITIME) EDUCATIONAL INSTITUTION
PERIOD
SPECIALISATIONGrade
College of Admiral Makarov State University of Maritime and Inland Shipping 9/1/20212/28/2026Судовождение
МК
0386614 4/15/2025
Harbour Master - Big port Saint Petersburg
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4124
474038 7/16/2024
ГУ МВД по городу Санкт-Петербургу и Ленинградской области
67 1636729 3/20/20253/20/2030
Ministry of Internal Affairs 0618 Page 2
Comments
Comments
Comments
Comments
RUS
0723156 4/22/20254/21/2030
Harbour Master - Big port Saint Petersburg

Page 3
Name of vessel Vessel TypeDeadweightEngine TypeEngine Power (kW) FlagManagement Company or
Crew Agent Rank
From To
1 23567 8910 11
Bogatyr-6 TUG1018Diesel 1525 RUSSIAN FEDERATION Cadet Deck
6/8/202410/29/2024
PAVEL CHIEF ENGINEER
Company Name
TelephoneE-mail
8(81378)28952 mail@vyborgshipyard.ru
SEA SERVICE (Complete sea service record for the last 10 years with the most recent record last)
PREVIOUS EMPLOYER'S DETAILS FOR REFERENCE
Go to the next sheet to continue…APPL IC ATIO N F O RM
PAO "VSZ" Person in charge

Page 4
Applicant
s name
MEDICAL HISTORY
Had you ever been signed off sick? Name of vessel
Had you ever been operated? Date
Date
6/19/2025
Rank
Type of ship
Date
Name of Crewing manager
Signature of Crewing manager No
IT IS VITAL THAT ALL ILLNESSES AND/OR INJURIES EXCEPT OF MINOR AFFECTIONS ARE DECLARED.
If yes, please provide following details
Date Brief description of illness, injury, accident
Agreement I agreeBrief description of surgery
Seafarer's obligation
I
herewith confirmthatallthe questions providedwiththisapplication formareclear tome. Iguarantee thatnoany ofmy
certificates hasever been revoked, suspended orfaked-up andIanswered truthfullytoall the questions tothe best ofmy
knowledge.
I agree withtheautomated processing ofmy personal dataspecified inthe questionnaire, withtheir transfer andstorage for
employment purposes
С автоматизированной обработкоймоихперсональных данных,указанных ванкете, сих передачей и
хранением в целях трудоустройства согласен If yes, please provide following details
6/19/2025 Saint-Petersburg I confirm
Date
Authorization for pre-employment process: Manager's notes
APPLICATION FORM
No
Place Confirmation
Настоящим
Яподтверждаю, чтовсе вопросы даннойанкеты мнепонятны. Ягарантирую, чтониодин из
моих сертификатов небыл обьявлен недействительным, действиениодного изсертификатов небыло
приостановлено ини один изних небыл подделан, иЯ ответил правдиво навсе вопросы сучетом известной
мне информации.
Please advise details of any injury and/or health problem during last 10 years: