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APPLICATION FORM |
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| Name: Akif | Surname: Gadisov | ||||||
| Date of birth: 08.11.1986 | Place of birth: Nikolaev | ||||||
| Permanent address: Nikolaev, Ukraine | |||||||
| Passport (OVIR): EA 384448 | Place of issue: Nikolaev | Date of issue: | Valid until: | ||||
| Seaman’s book: | Place of issue: | Date of issue: | Valid until: | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | . | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| National University of shipbuilding | Bachelor from ship power Installations | . | 01.06.2007 | ||||
| Nikolaev Center of seafarer's training | motorman | . | 22.07.2008 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00286/2008/07 | Nikolaev |
22.07.2008 |
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| Endorsement STCW | 00286/2008/07 | Nikolaev |
22.07.2008 |
02.04.2013 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 06015/2008/42/01 | Nikolaev |
02.04.2008 |
02.04.2013 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 04716/2008/42/02 | Nikolaev |
02.04.2008 |
02.04.2013 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| OM101 | Ukrrechflot | 119 | Ukraine | Passenger |
motorman |
05.05.2008 |
07.07.2008 |
| Experience at sea: Since 2008 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ BCA-530 | Issued: 07.07.2008 | Place: Nikolaev | Exp.date: 07.07.2009 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||
Ready to work from: any time