Матрос 1 класса

Описание




SEAFARER'S APPLICATION FORM
Name in full (First, Middle, Last):
Vladimir Eremin
Rank:
3[rd] off
PHOTO (please insеrtcolor / good quality photo )
Date & place of birth:25.11.1985
Nationality:RUSSIA

Marital status:
Single

Married
yes
Divorced

Widower

Nearest Airport (City / Country): Kaliningrad
Khrabrovo

Permanent Address ( full style):

Tel: 89520564340 Mob: 89114981339
e-mail: vlad_mir85@mail.ru Skype id: no
Social networks
Vkontakte:
Telegram: +79114908022
Next of kin (surname, name, date of birth):


Relationship: Eremina Marina
Address: Kaliningrad Schastlivay 11/48
Mob: 89114981339
e-mail: marinetka@list.ru
Close relatives (surname, name, date of birth):
Father: -

Mother: Alla Eremina 26/08/65

Wife or husband: Eremina Marina 11/10/85

Hair / eyes (colour): brown
Height (m): 181
Weight (kg)/ BMI: 76
Safety shoes size: 43
Safety overall size: 48-50
Children (surname, name, date of birth): Georgii Eremin 10/12/10 Alisa Eremina 19/05/17
Education (name & city of educational institution, dates of entry / graduation and degree): Navigator. KMRK Kaliningrad 30/06/22

YELLOW FEVER VACCINATION CERTIFICATE
COVID-19 VACCINATION CERTIFICATE
Country /Place issued:
Number:
Date issued:
Country /Place issued:
Vaccine
Date issued:
Russia
-
28/04/21
-


LICENCE INFORMATION (Certificate of Competency/Proficiency):
Country:
Grade of Licence:
Number:
Date issued:
Place issued:
Expiry Date:
National Licence
CERTIFICATE
KGD 207125531
10.08.2022
RUSSIA
31.05.2027
OTHER CERTIFICATES AND ENDORSEMENT INFORMATION:
Certificate/Endorsement
STCW Regulation No
Number /Type
Date issued:
Place issued:
Expiry Date:
GMDSS ( GOC / ROC)
A-IV/2
4.01.0135/2022 Restricted Operator
17.06.2022
Russia
17.06.2027
ARPA / Radar
A-II/1, A-II/2
AB № 1632640
30.06.2022
Russia
30.06.2027
ECDIS
B-I/12
AB № 1633514
01.07.2022
Russia
01.07.2027
Bridge / Engine Team
A-II / A-III




Ship Security Officer
A-VI/6-5




ISPS
A-VI/6-2
1.08.0156/2022
05.07.2022
Russia
05.07.2027
HAZMAT
B-V/b-5




Basic Safety Training
A-VI/1
1.05.0279/2022
26.05.2022
Russia
26.05.2027
First Aid // Medical care
A-VI/4-1 // A-VI/4-2
1.01.0578/2022
03.06.2022
Russia
03.06.2027
Survival craft & rescue boats
A-VI/2-1
AC № 1893982
31.052022
Russia
31.05.2027
Advanced Fire Fighting
A-VI/3
AC №1895982
22.07.2022
Russia
22.07.2027
SEAMAN'S BOOK, SEAFARER'S ID & PASSPORT INFORMATION:
Seafarer's ID No:
Place & Date Issued:
Expiry Date:
Travel Passport No:
Place & Date Issued:
Expiry Date:
RUS 0501685
RUSSIA
27.04.2026
66№4482373
RUSSIA 04.04.2023
04.04.2028
Other Flag
Seaman's Book No:
Place & Date Issued:
Expiry Date:
National Seaman's Book No:
Place & Date Issued:
Expiry Date:
CYPRUS CY335023
16.11.2021
15.11.2031
MK 0107304
RUSSIA 06.02.2012
-
VISA INFORMATION:

Visa:
Type:
Valid Until:
Remarks:
USA visa
-



Schengen Visa
-



LANGUAGE INFORMATION:

Good
Satisfactory
Poor
Remarks ( Marlins Test (%) , etc.)
English

medium

-
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RUSAM MARITIME AGENCY LTD

RECORDS OF PREVIOUS SEA SERVICE ( for previous 5 years)
Vessel's Name / year of build
Flag
IMO Number
DWT /
Type and Model of M.E., kW
Vessel's
Type / Deck Cranes
Rank
From
(date-month-year)
To
(date-month-year)
Months
Company
(Shipowner /Technical Manager/ Crewing Agency)
BOLICHE
Panama
9853072
62435 t
Bulk
AB
11.02.20
26.07.20
5
BULKSHIP MANAGEMENT AS
Ultra Incahuasi
Panama
9853083
62435 t
Bulk
AB
16.10.20
04.04.21
6
BULKSHIP MANAGEMENT AS
Sea Prospect
Cyprus
9516143
9385 t
General Cargo
AB
07.07.21
05.12.21
5
BULKSHIP MANAGEMENT AS
Ultra Incahuasi
Panama
9853083
62435 t
Bulk
AB
24.08.22
13.03.23
5
BULKSHIP MANAGEMENT AS
PATAGONMAN
Singapore
9521851
17083 t
Bulk
3[rd] off
12.05.23
07.09.23
3 m 26 days
BULKSHIP MANAGEMENT AS
REMARKS (Availability for service; Dry Dock experience; other languages; mix crew experience; other, etc.):

Signature of Seafarer:

Date:

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