Игорь

Applied Company:

National Certificates of Competence country____UKRAINE__________
Tanker Endorsements
Management level Operation level
Grade
Issued
Expires
Oil
Chemical
Gas
22437/2023
13,12,2023
06,12,2028,

FIRST CLASS

Valid Flag State Endorsements
Liberia X, Panama X, Malta , Marshall Islands , UK , Singapore Norway (NIS) ,
Italy Other (list flags)
GMDSS
General /Restricted

Flag State GMDSS Endorsements (list)

Other valid certificates and training attended
X Basic Safety Training XAdvanced Fighting XMedical First Aid X Medical Care ECDIS (Generic)
XShip Security Officer Bridge Team Management X Ship Handling Liquid Cargo Handling
X ER Management ECDIS (Type Specific) X Other (specify)
Education History: Name of Institution / Level / Graduate Date: OHEMS,ENGINEER,1981
Please answer the following questions:
• Did you suffer, or presently suffer from, any disease likely to render you unfit for services at sea or likely to endanger the health of other persons on board?
If yes, please provide details __________­­­­­­­­­­­_______
__________

NO
• Did you suffer any accident, which rendered you temporary and/or partially disabled?
NO
• Did you ever undergo psychiatric treatment
NO
• Are you addicted to alcohol or drugs of any kind?
NO
I hereby declare that the above facts and information are true and accurate. I further consent to the holding and processing by (i) the owners of any vessel on which I may be assigned from time to time and (ii) the Managers and any direct or indirect parent or subsidiary or associated or affiliated company of the Managers (together referred to as "the Companies") for the purposes of my employment, of personal data about me contained herein, or provided to any of the Companies at a later date, including with respect to personal and pensions administration, employee management and as required to comply with any laws, regulations or contracts applicable to any of the Companies or their businesses. I understand that this data will be stored in the Managers’ database for the purposes of my current or future employment arranged by the Managers. Further, I confirm that the above may involve the transfer of my personal data within the Managers’ organization.
Place__________ Date __________ Signature __________
For Office Use Only
Initial assessment of applicant for further recruitment
Comments

Responsible person

Name / Signature __________ Date __________
Sea Experience : (List the most recent experience first; use additional sheets as required)
Company
Flag
Vessel Name
Type (1)
GRT
DWT
Main Engine (2)
BHP
Rank
Date From
(dd/mm/yy)
Date To
(dd/mm/yy)
Reason for S/off (3)
MSC
SPAIN
MSC MANZOLLINI
CON

5800 TEU
MAN BW
58000
CHENG
02.12.2025
17.02.2025
EOC
DANAOS SHIPPING CO
LIB
INTEGRITY
BC

171000
MAN BW
20400
CHENG
01.05.2024
11.08.2024
EOC
DANAOS SHIPPING CO
LIB
INTEGRITY
BC

171000
MAN BW
20400
CHENG
01.09.2023
01.11.2023
EOC
DANAOS
MALT
CMA CGM RACINE
CON

6800 TEU
MAN BW
71000
CH ENG
16.12.2022
08.03.2023
EOC
DANAOS
MALT
ZIM SAN PAOLO
CON

4200 TEU
MAN BW
49680
CHENG
26.06.2022
01.10.2022
EOC
DANAOS SHIPPING CO
LIB
DERBY D
CON

4200 TEU
MAN BW
49680
CHENG
01.05.2021
20.11.2021
EOC
DANAOS
LIB
ANL TANGALA
CON

4200 TEU
MAN BW
49680
CH ENG
17.07.2020
06.11.2020
EOC
DANAOS
PAN
ADVANCE
CON

2400 TEU
MAN BW
26500
CHENG
06.06.2019
06.11.2019
EOC
DANAOS
LIB
DERBY D
CON

4200 TEU
MAN BW
49680
CHENG
05.10.2018
28.02.2019
EOC
DANAOS
MALT
ZIM DALIAN
CON

4200 TEU
MAN BW
49680
CHENG
30.12.2017
14.04.2018
EOC
DANAOS
MALT
ZIM ISTAMBUL
CON

4200 TEU
MAN BW
49680
CHENG
01.06.2017
30.09.2017
EOC
DANAOS
CYP
YM SEATTLE
CON

4200 TEU
MAN BW
49680
CHENG
25.04.2016
07.08.2016
EOC
DANAOS SHIPPING CO
PAN
FUTERE
CON

2400 TEU
MAN BW
26500
CHENG
20.09.2015
03.02.2016
EOC
NAVIOS SHIPPING CO
PAN
NAVIOS BUENO VEN
BC

180 000
MAN BW
25400
CHENG
2610.2014
10.04.2015
EOC
NAVIOS SHIPPING CO
PAN
NAVIOS HELIOS
BC

76400
MAN BW
14200
CHENG
16.02.2014
05.08.2014
EOC
NAVIOS SHIPPING CO
PAN
NAVIOS FULVIA
BC

180 000
MAN BW
25400
CHENG
24.05.2013
12.12.2013
EOC

(1) Use only the following abbreviations for vsl types:
(2) Engineers to give make/model of engines, e.g. “MAN 14V52/55A” or “SULZER 5RTA58”
(3) Reason of Sing Off, e.g. “EOC – End of Contract”, “MED – Medical Ground”, “OWN – Own request”
Please provide details of two recent employers who we may contact for references
Name of Company

Name of person to contact

Address

Telephone/E-Mail