Контактна інформація

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Додаткова інформація

S E A M A N ' s A P P L I C A T I O N F O R M
MARINE PRO SERVICE

A. SEAMAN'S PERSONAL DETAILS

POSITION TO APPLY FOR
2nd Mate
CERTIFIED FOR

NAME / SURNAME
Oleh Hariha
FATHER'S NAME

MOTHER'S NAME
Karaulova Evgeniya
D.O.B./P.O.B.

NATIONALITY
UKRAINIAN
Height (in cm): 176
Weight (Kg): 105
Shoes size:42,5
Parka size: 54-56
ADDRESS
34/262 Karbysheva str. < Kherson < Ukraine
MOBILE No.: [відкрити контакти](див. вище в блоці «контактна інформація»)
PHONE No.: [відкрити контакти](див. вище в блоці «контактна інформація»)
SKYPE ADDRESS: oleg.gariga
MARITAL STATUS

MARRIED
YES NO
CHILDREN
YES NO
HOW MANY UNDER
18 YRS OLD
NEXT OF KIN
Karaulova Evgeniya
RELATION
Mother
SEAMAN'S PASSP NO.
AB 551107
ISS / VALID DATE
06.03.2015 /06.03.2020
CIVIL PASSP NO.
MP 440696
ISS / VALID DATE
30.08.2014
GRADUATED FROM
Kherson Maritime college 2003 - 2009
ENGLISH ABILITY
FLUENT
VERY GOOD
GOOD
FAIR

B. NATIONAL CERTIFICATION
CERTIFICATE
NUMBER
ISSUING - VALIDATION DATE
ISSUING PLACE
CERTIFICATE OF COMPETENCY
13812/2014/11
Kherson 17.11.2014
12.11.2019
ENDORSEMENT OF CERTIFICATE
13812/2014/11
Kherson 17.11.2014
12.11.2019
GMDSS CERTIFICATE
13811/2014/11
Kherson 17.11.2014
11.11.2019
ENDORSEMENT OF GMDSS
13811/2014/11
Kherson 17.11.2014
11.11.2019
SHIP SECURITY OFFICER
7806
Nikolaev 10.09.2014
10.09.2019
BASIC SAFETY
22170
Nikolaev 10.09.2014
10.09.2019
PROFICIENCY IN SURV CRAFT
17792
Nikolaev 10.09.2014
10.09.2019
ADVANCED MEDICAL FIRST AID
9649
Nikolaev 10.09.2014
10.09.2019
ADVANCED FIRE FIGHTING
14977
Nikolaev 10.09.2014
10.09.2019
RADAR, ARPA (DECK OFF.)
2182
Nikolaev 10.09.2014
10.09.2019
DANGEROUS SUBSTANCES
10942
Nikolaev 10.09.2014
10.09.2019
SECURITY RELATED TRAINING
09036
Kherson 03.12.2013
03.12.2018
DESIGNATED SECURITY DUTIES
29288
Nikolaev 10.09.2014
10.09.2019
ECIDIS
6731
Nikolaev 10.09.2014
10.09.2019
To be filled if any additional certs

To be filled if any additional certs

To be filled if any additional certs

To be filled if any additional certs

BRIDGE TEAM MNGMNT
7135
Nikolaev 10.09.2014
10.09.2019
LAST MEDICAL

VACCINATIONS

YELLOW FEVER : DOI 18.072013 DOE 18.07.2018
CHOLERA : DOI………………………. DOE ……………………….

C. FLAG CERTIFICATION

FLAG

TYPE / No.
(S.BOOK/ENDORS/STICKER)

RANK

ISSUED

VALID

Based on NATIONAL
ENDORSEMENT
NUMBER
MALTA
Endorsement/13812/2014/11, 13811/2014/11
OOW Navigation
30.06.16
11.11.19
MALTA 158967

D. PREVIOUS SEA SERVICE
VESSEL
FLAG
TYPE/DWT
ENG/HP
RANK
S/ON
S/OFF
OWNERS
Uniland
St.Vinsent
Gen cargo/6179
Deutz/2850
Bosun
24.02.10
25.05.10
Uniship LTD
Tase
St.Vinsent
Gen.cargo/2765
SKL/1030
2nd Mate
17.08.10
24.12.10
S.Group Maritime LTD
Azov Trader
St.Kitss
Gen.cargo/8035
Deutz/4415
2nd Mate
25.05.11
15.10.11
Irania Trading INC
Siderfly
St.Vinsent
Gen.cargo/4380
Deutz/1228
2nd Mate
18.07.13
19.09.13
Deleclass Shipping Co LTD
Palmira
Cambodia
Gen.cargo/2893
Skoda/1030
2nd Mate
07.02.14
25.07.14
Sandtrader LTD
Nadezhda
Malta
Gen.cargo/5862
G63/2206
2nd Mate
26.04.16
24.09.16
Asmar Shipping Limited/Transyug

Version: 7/03 . Seaman’s Signature……………………………