APPLICATION FORM
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APPLICATION FORM |
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| Name: George | Surname: Gordeladze | ||||||
| Date of birth: 10.10.1948 | Place of birth: Georgia | ||||||
| Permanent address: Batumi, Georgia | |||||||
| Passport (OVIR): 05AC 46410 | Place of issue: Georgia | Date of issue: 06.09.2006 | Valid until: 06.09.2016 | ||||
| Seaman’s book: 011307 | Place of issue: Georgia | Date of issue: 11.08.2005 | Valid until: 11.08.2015 | ||||
| Citizenship: Georgia | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | . | ||||||
| Supported children under age of 18 | Son - Davit Gordeladze - pass.#05AB90208 | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Very good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| College | |||||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 03.07112.181 | Georgia |
29.09.2003 |
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| ISPS code Familization | 043704 | Georgia |
24.11.2004 |
02.11.2009 |
| Personal Safety & Social responsibility | 202804 | Georgia |
24.11.2004 |
29.10.2009 |
| Personal Sea Srivival, fire prevantion & fire fighting | 202804 | Georgia |
24.11.2004 |
29.10.2009 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 217104 | Georgia |
24.11.2004 |
29.10.2009 |
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Tanker Certificates |
. |
. |
. |
. |
| Tanker Familiarization | 151704 | Georgia |
24.11.2004 |
29.10.2009 |
| Shore-based fire fighting | 151704 | Georgia |
24.11.2004 |
29.10.2009 |
| Crude oil washing | 156204 | Georgia |
08.12.2004 |
15.11.2009 |
| Inert gas system | 156204 | Georgia |
08.12.2004 |
15.11.2009 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Anna | Olimpia | 9000 | Georgia | TNK | Motorman |
22.01.2003 |
20.09.2003 |
| 2. Bonavis | Olimpia | 42000 | Panama | Bulker | Fitter |
02.11.2003 |
20.08.2004 |
| 3. Nik Meri | Olimpia | 16000 | Majuro | TNK | Fitter |
07.03.2005 |
10.06.2005 |
| 4. Bismark Wind | Eastwind | 32000 | Majuro | TNK | Fitter |
16.08.2005 |
10.07.2006 |
| 5. Azov Wind | Eastwind | 16500 | Liberia | TNK | Fitter |
25.09.2006 |
03.04.2007 |
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Experience at sea: Since 1980 |
Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | Issued: | Place: | Exp.date: | |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid untill: 18.05.2010 | |||
Ready to work from: any time