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Application for Employment.
| Position applied for: AB
| Address: Ukraine, Odessa, 6-Statiopn Lystdorfskoi str, 17 line, ap.44
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| | Surname: Gorelov
| | Forenames: Pavlo Volodymirovich
| Tel.:
| Cont.Tel: +380957052695
| | Date of Birth: 03.11.1984
| Marital status: Single
| No of Children:
| | Place of Birth: Ukraine, Odessa/Украина, Одесса
| | Nationality: Ukrainian
| Date, Place issued: 02.08.2002 Odessa
| | Native Language: Ukrainian
| | Languages spoken: Russian, English
| Passport: KK 682692
| | Education: Secondary
| Next of Kin (Father): Gorelov Volodymir Serafimovich
| | Education Body: School №56 2002year
| Address: Ukraine, Odessa, 6-Statiopn Lystdorfskoi str, 17 line, ap.44
Tel.: +380678413555
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| Licenses
| Grade
| Number
| Date Issued
| Education Body
| Expiry Date
| | Certificate of Competence
| AB
| 00052/2011/08
| 20.01.2011
| Harbour Master of seaport of Osessa
| 31.12.2016
| | Flag St. Recognition Cert
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| | Flag St. Recognition Cert
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| | Flag St. Recognition Cert.
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| | GMDSS
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| | Endorsement of GMDSS
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| | Radar Observ. Simulator
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| | ARPA
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| | Survival craft & rescue boat
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| 3/AC/0466/0/13
| 28.05.2013
| Illichivsk “Training Centre Of Seafarers AVANT”
| 28.05.2018
| | Advanced Fire-Fighting
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| 3/AA/0694/0/13
| 28.05.2013
| Illichivsk “Training Centre Of Seafarers AVANT”
| 28.05.2018
| | Carriage of D-s & Has-s sub-s
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| 0935/2013
| 16.08.2013
| Centre Of Survival At Sea Of Odessa National Maritime Academy
| 16.08.2018
| | First Aid at Sea
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| 3/AA/0694/0/13
| 28.05.2013
| Illichivsk “Training Centre Of Seafarers AVANT”
| 28.05.2018
| | Basic safety training
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| 3/AA/0694/0/13
| 28.05.2013
| Illichivsk “Training Centre Of Seafarers AVANT”
| 28.05.2018
| | Watchkeeping
| AB
| 3/CG/0086/0/13
| 28.05.2013
| Illichivsk “Training Centre Of Seafarers AVANT”
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| Document
| Number
| Date Issued
| Place Issued
| Expiry Date
| | Seaman's Passport
| AB 520259
| 13.06.2013
| Port of Illichivsk
| 13.06.2018
| | Seaman's Book
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| | Travel Passport
| EE 267424
| 10.07.2008
| Odessa
| 10.07.2018
| | US Visa
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| | Health Certificate
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| 06.06.2013
| Odessa, Ukrainian scientific-Research institute of Transport Medicine
| 06.06.2014
| | Yellow Fever
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| 22.07.2008
| Odessa, Ukrainian scientific-Research institute of Transport Medicine
| 22.07.2018
| | Drug and Alcohol
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| 06.06.2013
| Odessa, Ukrainian scientific-Research institute of Transport Medicine
| 06.06.2014
| | Schengen visa
| PL 5660227
| 06.12.2008
| Odessa
| 10.12.2008
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| Eyes: Brown
| | Hair: Black
| | Height: 202
| | Weight: 93
| | Shoes: 45
| | Overall: 6/56
| Previous Sea Experience (for last 10 Years)
| From
| To
| Vessel
| Flag
| DWT
| HP
| Engine
| TypeOfVessel
| Position
| Company
| Com. Tel
| | 28.11.08
| 03.03.09
| Boris Dwerevyanko
| Ukraine
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| 2*1500
| B& W
| Fish-hunt
| Insulator
| RSK “Kapitan”
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| | 15.07.09
| 11.11.09
| St.Sophia
| Moroni
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| 2*1200
| G-70
| General Cargo
| OS
| Neoimpex corporation, KA-TRANS
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| | 26.03.10
| 08.10.10
| Skulptor Tomskiy
| Belize
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| 9600Kw
| B& W
| Reefer
| Deck Cadet
| FWSM, Sea Brothers
| +78123239133
| | 01.05.11
| 24.09.11
| Consul
| Phnom-Penh
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| 2*870
| NVD
| General Cargo
| Bosun
| MD Shipping, Azimut Crewing
| +380482334339
| | 05.05.12
| 06.08.12
| Rainbow
| Phnom-Penh
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| 2*760
| NVD
| General Cargo
| Bosun
| MD Shipping, Azimut Crewing
| +380482334339
| | 02.09.13
| 16.03.14
| Ocean Brother
| Malta
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| Makita-Mitsui-Man
| Bulk-Carrier
| AB
| FWSM, Sea Brothers
| +78123239133
| | 12.12.14
| 13.09.15
| Verlaine
| Phnom-Penh
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| 2*760
| NVD
| General Cargo
| AB
| Adler Shipping
| +79788069429
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| С автоматизированной обработкой моих персональных данных указанных в анкете, их передачей (включая трансграничную) и хранением в целях трудоустройства согласен.
Подпись Горелов П.В.
Дата 11.10.2015
Готовность в рейс: 100%
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