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Wage (min) ___400$__
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Records of Service for last 7 years
Ship’s name
Year of built
| Type DWT | Main Engine Type Modification | Power BHP KWT | Country (Flag) | Owner/Manager
 Crew Agent
| Position | Period
from (d/m/y)
 till (d/m/y)
|
 Rodnik 1971
|  Ukraine
| Port Odessa | OS-cadet |  17.05.1231.08.12
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| Diorit
| Ukraine
| Port Odessa | OS-cadet | 10.01.1211.03.12
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| Hamburg 1999
| Moldova
| Russia Maritime Shipping | OS | 10.01.1421.07.14
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Contact details of previous Employers
| Name of Ship | Crewing Agency / Shipowner | Tel. numbers / Address | Person in charge |
Wage (min) ___________400$______________________
| C1 | Marital status Single | C2 | Children under the age of 18 - | |
| C3 | Next of kin Iliasova Tatiana Genadievna |
| D1 | Color of hair: black Color of eyes: blue | ||||
| D2 | Height: 180 | Weight: 65 | Boiler suite size: 32 | Safety shoes size: 43 |
| E1 | National Passport # КМ701364 Issued 11.02.11 By | |
| E2 | Identification Code # 3473110091 | |
| E3 | Tourist Passport # EP859531 Issd 21.03.13 exp 21.03.23 | |
| E4 | Seaman’s Passport AB # 506242 Issd 11.01.13 exp 11.01.18 | |
| E5 | Other Countries Seaman’s Book: | |
| Country # Issd exp | ||
| E6 | Education (educational institution name): Odessa Maritime College of the Fishing Industry Period from (d/m/y) till (d/m/y): 01.9.10/31.6.15 |
| Certificates | ||
| F1 | Competency: Grade # 00436/2013/08 Issd 21.05.13 exp | |
| Endorsement #00436/2013/08 Issd 21.05.13 exp 08.02.18 | ||
| F2 | STCW’78/95 – A-VI/1 # 4/059/12 Issd 10.02.12 (personal survival, fire prevention, elementary first aid & social responsibilities) | |
| F3 | Proficiency in survival craft # 4/548/12 Issd 03.12.12 exp 03.12.17 & Rescue Boats | |
| F4 | Advanced fire fighting # 4/AE/0043/0/13 Issd 08.02.13 exp 08.02.18 | |
| F5 | Ship’s medical care # 4/356/12 Issd 03.12.12 exp 03.12.17 | |
| F6 | Others: | |
| Training for personnel serving on passenger ships other than RO-RO passenger ships # 4/BV/0015/0/13 Issd 08.02.13 exp 08.02.18 | ||
| Security training for seafarers with designated security duties # 5622/2015-A issd 17.06.15 exp 17.06.20 | ||
| Tanker familiarization # 4/BN/0028/0/13 issd 08.02.13 exp 08.02.18 |
| G1 | Medical examination and vaccination | |
| Yellow Fever: issue date | ||
| Last medical examination: issue date |
Remarks:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
| Seafarer’s Signature |
| Date 05.11.15 |
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