Рефмеханик

Описание

SEAFARER'S APPLICATION FORM - Page 1 of 3 - PERSONAL DATA
PERSONAL INFORMATION
Family Name
Kiberev
First Name (s)
Vyacheslav
Birth Date
25.11.1973
Birth Place
Russian Sakhalin
Nationality
Russian Federation
Religion
orthodoxy
Marital Status
It is married
No. of Children
The son
Height (cm)
178
Weight (kg)
90
Nearest Airport
The wife Kibereva Elena
Alternative Airport

ADDRESS (include telephone country & area codes, advise also secondary or contact addresses if any)
Street & Nr.
Shalavina&49 flatee 81 korp. 3
Email Address
vkiberev@mail.ru
Location
Region Leningradskaya
Mobile Phone
+7(924) 186 3411
+7(911)085-1445
City
Sankt-Petersburg
Residence Phone
no
State, Country
Russian Federation
Fax
no
Postal (ZIP) Code
1888820
P.O. Box (if any)
no
NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary)
Family Name
Kibereva
First Name(s)
Elena
Nationality
Russian Federation
Relationship
The wife
Street & Nr.
Shkolnaya&18-9
Email Address
smile-helen@yandex.ru
Location
Region Sakhalin
Mobile Phone
+7(984) 180 3805
City
Kholmsk
Residence Phone
no
State, Country
Russian Federation
Fax
no
Postal (ZIP) Code
694620
P.O. Box (if any)
no
REMARKS
Requested Rank
refrigerator engineer officer
Availability Date
january
Prefer. Vessel Type
refrigerator
Minimum Salary
5000 GBP
English Language Skills
Spoken: fluent / good / average / poor - Written: fluent / good / average / poor
Other Foreign Languages
no
Professional School / Academy - Name & Period (From - To)
Passed examinations of Sakhalin secondary marine college from 1993 to 1997 for second class refrigerator engineer officer


Foreign Crew Experience
(specify nationalities)
no
Other Skills
Petrotechnics ISSOW certificate; Sakhalin Energy permit to work essentials
Further Remarks
no
Please advise how you heard about Vroon Shipping:
(underline appropriate option)
Newspaper / Advert/ Google / Internet / Relative / Other Seafarer School / University / Other sources - ... Other sources / Google

I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge.
Date:

Signature:

Note: This form can be returned per email without signature - please ensure however to send a signed printout for our records afterwards per mail (e.g. with the passport photos and photo copies required). Please sign all 3 pages of the application form separately.

Crew Dept - (REC) - Tel: +447509756395- Email: marineshipping6@gmail.com

















SEAFARER'S APPLICATION FORM - Page 2 of 3 - LIST OF DOCUMENTS

Please note that due to legal requirements employment is only possible once we are in possession of electronic copies of your documents and licenses (please refer to the Cover Letter for further instructions).

Family
Name
Kiberev
First
Name(s)
Vyacheslav
Rank

A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES
Document Name (Description)
Document Number
Country
Issue Place
Issue Date
Exp. Date
Passport
71 2331322
RUS
FMS 65001
29.10.2010
29.10.2020
Seaman's Book (national)
MK 0016520
RUS
JSC"KurilskyRybak"
26.08.2011

Seaman's Book (flag state)
0328738
RUS
FSBI Sakhalin
02.09.2016
01.09.2021
Seaman's Book (flag state)





Visa - United States (type C1/D)
no




Visa - Others (Work/Reside. Permits)
no




Medical Examination Report
AE0570501
RUS
FBUZ
10.03.2017
10.03.2022
Drug & Alcohol Test





Vaccination against Yellow Fever





Vaccination against Cholera





Passport Photos
please email a high quality copy of a recent passport photo.
B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES
- Deck & engine certificates &endorsements (officers / ratings)
- electrical & reefer certificates
- cook & steward certificates
- radio certificates & endorsements
- safety training (surv., fire, medical)
- tanker courses (oil, chem., gas)
- passenger vsl, roro, hazmat courses
- nav., deck, technical & management
courses (radar/ARPA, ISM, Marpol,
Simulators, computer, welding etc.)
- any flag state certificates
Document Name (Description)
Document Number
Country
Issue Place
Issue Date
Exp. Date
Certificate Second class refrigerator engineer officer
3215200081
RUS
АМП ФГБУ Невельский филиал
13.03.2017
12.03.2022
Certificate Training of seafarers with designated security duties (Section A-VI/6, table A-VI/6-2)
AA 0428536
RUS
Training center STC"Kadry-moreprodukta
18.112016
18.11.2021
Certificate Medical first aid (Section A-VI/4, table A-VI/4-1)
AA 0293795
RUS
Training center STC"Kadry-moreprodukta
21/11/2016
21/11/2021
Certificate Advanced fire fighting (Section A-VI/3, table A-VI/3
AB 0527139
RUS
Shore-based training center "Marine Training Centr"
30/11/2016
30/11/2021
Certificate Basic safety training (Section A-VI/1, tables A-VI/1-1,A-VI/1-2, A-VI/1-3, A-VI/1-4
AB 0526901
RUS
Shore-based training center "Marine Training Centr"
28/11/2016
28/11/2021
Certificate Proficiency in survival craft and rescue boats other than fast rescue boats (Section A-VI/2, table A-VI/2-1)
AB 0527522
RUS
Shore-based training center "Marine Training Centr"
29/11/2016
29/11/2021
Certificate Medical
24524487
RUS
FBUZ The centre of hygiene and epidemiology in the Sakhalin region
21/01/2018
21/01/2019

Date:


Signature:
































Crew Department (Recruitment Group) -Tel: +447509756395- Email: marineshipping6@gmail.com

SEAFARER'S APPLICATION FORM - Page 3 of 3 - SEA SERVICE (LAST 10 YEARS)

Please indicate your sea service in the last 10 years as exactly as possible - required are the actual sign-on and sign-off dates according to the service certificates resp. seaman's book entries. To speed up processing kindly indicate phone and/or fax numbers of your previous employers. Ship sizes are to be indicated in gross tons, total engine output in kilo Watt (1 kW = 1.34 bhp) to go along with STCW limitations. Please attach evidence for the listed sea service (copies of seaman's book entries, service certificates etc.). The information provided may be passed on to our clients and to flag state administrations to allow for verification of rank experience. Please use the European date format (DD.MM.YY).

Family Name:
Kiberev
First Name(s):Vyacheslav

Date of Birth:
25/11/1973

Vessel's Name
IMO No.
Flag
GT
kW
Ship Type
Eng.Make
Rank
S/On Date
S/Off Date
Employer (company to contact for reference)
RTM "Tor"
8514928
G-0746
Russia
862/862
1940
Fishing
DBC AN 40 AKD
Refrigerator engineer officer
04/03/2008
02/11/2011
JSG "KurilskyRybak "t/89147592074
RSH "Star-1"
8317318
G-0750
Russia
197/197
592
Fishing
DBC 5 PA 5 L
Refrigerator engineer officer
23/03/2012
03/11/2012
JSG "KurilskyRybak "t/89147592074
RTM "Tor"
8514928
G-0746
Russia
862/862
1940
Fishing
DBC AN 40 AKD
Refrigerator engineer officer
07/11/2012
22/05/2013
JSG "KurilskyRybak "t/89147592074
M/V "Capitan Mokeev"
9081667
Russia
6971/6971
5100
Refrigerated cargo ship
6 DKRN 42/136/10
Refrigerator engineer officer
05/10/2013
20/03/2014
JSC "Gidrostroy" "t/89147592074
RT "Taimania"
8803733
G-0896
Russia
703/703
1838
Fishing
DBG S5V 9M 628
Refrigerator engineer officer
14/042014
12/12/2014
JSG "KurilskyRybak "t/89147592074
SRTM "Bratteg"
86/9560
Russia
1630/1630
1940
Fishing
Bergen Diesel KVMB-12
Refrigerator engineer officer
18/05/2015
5/06/2016
OOO PCF
"Yuzhno-KurilskyRybocombinatCo.,LTD"
t.+7(42455)22265
SRTM "Bratteg"
869560
Russia
16030/163
1940
Fishing
Bergen Diesel KVMB-12
Refrigerator engineer office
12.04.2017
4.01.2018
OOO PCF
"Yuzhno-KurilskyRybocombinatCo.,LTD"
t.+7(42455)22265

































Date:

Signature: