Scribd
Upload
1K views2 pages

Application Form General Template

This document is an employment application form submitted by Alex Yefimenko, a Ukrainian national born in 2000, for the position of Motorman 2 class. It includes his personal details, documents, licenses, certificates, sea service experience aboard the bulk carrier Mykomos Bay from 2020-2021, and contact information for references and his next of kin.

Uploaded by

Alex Efimenko
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
1K views2 pages

Application Form General Template

This document is an employment application form submitted by Alex Yefimenko, a Ukrainian national born in 2000, for the position of Motorman 2 class. It includes his personal details, documents, licenses, certificates, sea service experience aboard the bulk carrier Mykomos Bay from 2020-2021, and contact information for references and his next of kin.

Uploaded by

Alex Efimenko
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 2

EMPLOYMENT APPLICATION FORM

Rank: Motorman 2 class Date Available for Joining:


Vessel:

Personal details
Surname: Yefimenko First name: Alex      Photo:      
Date of birth: 23.04.2000 Place of birth: Ukraine Nationality: Ukranian
Home address: limanna 21-a
Phones: 0995165223

Nearest airport: Nearest international airport:

Documents

Passport No. FX225813 Issued on: 23.08.2019 Expiry date: 23.08.2029


S/book No. Issued on: Expiry date:
US visa C1/D Issued on: Expiry date:

LICENCE PARTICULARS
MOT Grade Cert No Place of Issue Date of Issue Expiry date
National License
Endorsement
Tanker endorsement Crude Oil
Liquid chemical
Liquefied gas
Shuttle Tanker Log Book
DP Log Book NI
DP Log Book DNV

CERTIFICATES Cert No Date of Issue Expiry date


G.M.D.S.S.
G.M.D.S.S. Endorsement
Proficiency In Survival Craft 1337520 09.06.2021 09.06.2026
Basic Safety Training 1435 20.02.2018 20.02.2023
Advanced Fire Fighting 1337521 09.06.2021 09.06.2026
Dangerous And Hazardous Substances D 168/20 27.08.2020 27.08.2025
ROP/ARPA
Ship Security Officer
Medical First Aid
DP Induction Course
DP Advanced Course
DP Unlimited Certificate
Bridge Team Management
Bridge Resourse Management
ECDIS
ECDIS Type Specific
Security-related training & instruction for all SA 450/20 21.07.2020 21.07.2025
seafarers
Designated Security Duties SD 423/20 28.07.2020 28.07.2025
Ship Security Officer
H2S
Yellow fever

Pre-SEA Training / Nautical School / Maritime School Qualifications Passed:

1
SEA SERVICE
Year Type of Vessel
Name of Vessel Flag DWT and HP Rank Period of Service Name of Owners
Built and Engine (Type)
Isle of Man
Mykomos Bay 2010 Bulk carrier 21497;6480kW; Trainee Messman 30.08.20020 25.04.2021 PNR MARINE TRADING V LLC
man
mmmmmm

References Exp. with Multinational Crew:


Name of company: Nationalities:
 No.
Name of company: Level of English good
 No. Marlins Test %

Next of kin Personal data:


Name/Relationship Weight, kg: 85 Height, cm: 197
Home address: Eyes: Blue Hair: White
Phones: Overall size: Safety shoes: 46

About you:

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy