Application For Staff Employment

AP-01

Positions applied for: 1) ABLE SEAMAN 2) 3-rd officer 3)

Expected Salary: 1800$ Date of readiness: Ready to work
Surname: GARIBYAN Name: LEO Photo
Father’s name: ARTUR Mother’s name: KRISTINA
Date of birth: 12.01.1997 Place of birth: GEORGIA BATUMI
Nationality: GEORGIAN Marital status: SINGLE N of children under 18 /

Home Address: Griboedov str.36/App.41 Contact Phone: +995 557 94 88 08

E-mail: leo-garibyan@mail.ru Skype:

Next of kin: KRISTINA OSTAPOVA Relation: MOTHER

Next of kin’s address: PUSHKIN str 129/131 ft 43 Next of kin’s phone №: 577 13 73 15
Height (cm): 180 Weight (kg): 100 Size of: Overall (EUR): 52 Shoes (EUR): 45
Eyes Colour: hazel Hair Colour: hazel Blood Group: 2 BMI:
English: Marlins, % CES 4.1, % Psycho test:
PASSPORTS and CERTIFICATES
DOCUMENT NUMBER ISSUED DATE VALID UNTIL PLACE
TRAVEL PASSPORT: 15AB37331 06.04.2016 06.04.2026 GEORGIA
SEAMAN’S BOOK: S011440 15.03.2024 14.03.2034 GEORGIA
CIVIL PASSPORT:
U.S. VISA:
OTHER VALID VISA:
CERTIFICATE OF COMPETENCY # 1 MTA-00-011776 31.08.20 31.08.2025 GEORGIA
RANK / CAPACITY AB
ENDORSEMENT OF CERTIFICATE # 1
CERTIFICATE OF COMPETENCY # 2 22GS05-13-007056 05.05.22 05.05.27 GEORGIA
RANK / CAPACITY 3rd-officer
ENDORSEMENT OF CERTIFICATE # 2
CERTIFICATE NUMBER ISSUED DATE VALID UNTIL PLACE
BASIC SAFETY TRAINING BST02-185102 27.03.23 22.03.28 GEORGIA
PROFICIENCY IN SURVIVAL CRAFT FRB02-207265 18.01.2024 16.12.2028 GEORGIA
ADVANCED FIRE FIGHTING AFT02-155653 21.02.22 07.02.2027 GEORGIA
MEDICAL FIRST AID MEDICAL CARE MFC02-155652 21.02.22 25.12.2025 GEORGIA
SHIPS SECURITY OFFICER SSO02-155681 21.02.22 15.12.2026 GEORGIA
DESIGNATED SECURITY DUTIES
SECURITY AWARENESS SEC02-185101 27.03.23 24.02.28 GEORGIA
SHIPS SAFETY OFFICER / ISM
GMDSS CERTIFICATE/ENDORSEMENT 22G09-23-003446 23.02.22 21.02.2027 GEORGIA
RADAR NAVIGATION, RADAR PLOTTING AND RNA02-155683 21.02.22 22.02.2026 GEORGIA
USE OF ARPA
DANGEROUS & HAZARDOUS CARGOES
BRIDGE TEAM MNGT/ BTM02-155668 21.02.22 12.02.2026 GEORGIA
ENGINE ROOM RESOURCE MNGT
ECDIS GENERIC ECS02-155659 21.02.22 14.01.2027 GEORGIA
SPECIFIC CERTIFICATES
BASIC TRAINING FOR OIL AND CHEMICAL
TANKER
ADVANCED TRAINING FOR OIL TANKER OCG02-155644 21.02.22 05.02.2026 GEORGIA
ADV. TRAINING FOR CHEMICAL TANKER OCG02-155644 21.02.22 05.02.2026 GEORGIA
ADVANCED TRAINING FOR GAS TANKER
PROFICIENCY IN FAST RESCUE BOATS
ICE NAVIGATION
HIGH VOLTAGE EL. EQUIPMENT
ECDIS SPECIFIC
COOK / MESSMAN (MLC-2006)

FOREIGN SEAMAN’S ID / RECORD BOOKS

Version 02. Origin Date: 15 November 2013. Version Date: 09 November 2016.
Prepared by: Quality Manager. Approved by: Crewing Director. Validated by: Quality Manager. 1/3
 Application For Staff Employment
AP-01

DATE: 04.07.22 Signature: GARIBYAN

Version 02. Origin Date: 15 November 2013. Version Date: 09 November 2016.
Prepared by: Quality Manager. Approved by: Crewing Director. Validated by: Quality Manager. 2/3
 Application For Staff Employment
AP-01

EDUCATIONAL ESTABLISHMENT GRADUATED FROM / Year /

DEPARTMENT CURRENTLY STUDYING / Course /

PREVIOUS SEA SERVICE

FROM TO POSITION SALARY NAME OF VESSEL SHIPOWNER TYPE OF VESSEL TYPE OF ENGINE DWT BHP FLAG CREWING AGENT
31.03.18 8.09.2018 deck/cadet 400 VEMAOIL XIV QUEENSWAY oil/ch.tanker HANSHIN 4825 MALTA QUEENSWAY
24.07.19 07.03.20 deck/cadet 400 VEMAOIL XXIII QUEENSWAY oil/ch.tanker akasaka 8255. MALTA QUEENSWAY
76
12.09.20 29.11.20 AB 1200 VEMAHONESTY QUEENSWAY oil/ch.tanker MAK 6388. MALTA QUEENSWAY
2
12.03.21 24.09.21 AB 1200 SUNPOWER QUEENSWAY ASPHALT 8320ZCd 4999 PANAMA QUEENSWAY
14.07.22 12.01.23 AB 1600 ATILA LUMUS CRUDE OIL MITSUI MAN 3006 CAMERO LOMAS
CHARTERING LTD TANKER(VLCC) B&W 7S80MC-C 67 ON Maritime
12.05.23 21.11.23 AB 1800 PROMETEI Oil/prod 4589 PALAU
tanker 7

BRIEF INFORMATION ABOUT PREVIOUS EMPLOYERS

COMPANY PERSON IN CHARGE CONTACT DETAILS (Phone Number, e-mail)

I hereby confirm that above information is true and correct to the best of my knowledge. I understand that this information will be held in the computer database due to my real or possible employment. Signing
it, I willfully give my permission to collect and process my personal information and to use it in all and legal way. I give my permission for my personal information to be provided to the possible employers and
any other persons, if such need arises for my employment. Besides, I permit the EUROBULK AGENCY LLC employees to request personal information (data) about me from my former employers.
Date: 04.07.22 Signature: GARIBYAN

Version 02. Origin Date: 15 November 2013. Version Date: 09 November 2016.
Prepared by: Quality Manager. Approved by: Crewing Director. Validated by: Quality Manager. 3/3