Рефмеханик

Описание

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APPLICATION FORM


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Position applied for: REF.ENGINEER Date available: 05.03.2018 Min salary USD: 4500



1 Personal details
Name: (Last Name): EFREMOV
(First names): IGOR
Date/place of birth: 26.04.1963 Nationality: RUSSIAN
Permanent address: Street: PROSPECT POBEDY 84-28
Post code: 236010 City: KALININGRAD
( Mailing address: Street: PROSPECT POBEDY 84-28
Post code: 236010 City: KALININGRAD
@ E-mail: IGOREF63@MAIL.RU ( No.: ( No.: +7(4012)33-23-77
Mobile phone: +79114949487 Skype address: IGOR.IGOR3730
Height (cm): 177 Weight (kg): 63
Colour of eyes: GREY Colour of hair: GREY
Marital status: MARRIED Father’s name: ALEXEY
Nearest airport: KALININGRAD

2 Education Background
School / College From To Highest Qualification Attained
KALININGRAD HIGHER ENGINEERING MARINE 1984 1989 REF.ENGINEER 1st CATEGORY
SCHOOL

3 Identity documents
DOCUMENT Country Number Issued date Expiry date Place
Travel passport: National 73 6057768 11.09.2014 11.09.2024 KALININGRAD
Seaman’s passport National
Seafarer’s Identity Document National RUS 0229246 27.10.2015 26.10.2020 KALININGRAD
Seaman’s book: National MK 0085007 30.09.2011 PERMANENT KALININGRAD

Do you hold a US Visa ‘C1/D’? YES NO Valid until:
Have you been rejected for any visa applied for? YES NO
If YES, please state the country and reasons
Do you hold Schengen visa? YES NO Valid until:12.01.2019

4 Next of kin
Name: (Last Name): EFREMOVA (First Names) : LUDMILA
Relationship: WIFE
Address: PROSPECT POBEDY 84-28
Post code: 236010 City: KALININGRAD
( No.: Home: 33-23-77 Mob. 89114949487

5 Health Certificates
Issue date Expiry date
International Health Cert. 01.03.2018 01.03.2020
Vaccination against Yellow fever 11.10.2017 PERMANENT
Drug & Alcohol test 28.02.2018



6 Certificates of competency
Class / Grade Number Place / Country Issued Issue date Expire date
1st CATEGORY REFRIGERATION 1045105692 KALININGRAD SEA PORT AUTORITY 14.02.2012 02.12.2021
ENGINEER OFFICER RUSSIA




7 Courses attended and certificates obtained
Course name Number Issue date Expire date Issued by Issued at
Basic safety training (SOLAS) 0709880 02.12.2016 02.12.2021 BALTIC STATE KALININ-GRAD
ACADEMY
Advance Fire Fighting 07711500 07.12.2016 02.12.2021 - -
Elementary First Aid
Medical First Aid 0713118 12.12.2016 12.12.2021 - -
Medical Care
Personal Survival Techniques
Personal Safety & Social Responsibility
Proficiency In Survival Craft 0712195 05.12.2016 05.12.2021 - -
GMDSS
ARPA
Radar
Ship Security Officer Course
Seafarers with Designated Security Duties 0563318 16.12.2016 16.12.2021 - -
Other:



8 Languages
Fluent Very good Good Poor Satisfactory
English YES



9 Bank account information (optional)
Bank Name:
Address:

Account No.:
Swift code:
Owner name:
Owner address:

10 References (Please give the name and address of your current or immediate past employer)
Name of company: SOKAN ARVAND SHIP MANAGEMENT CO.
Name of person to contact: SHAHROKH AMMARY
Address: TEHRAN IRAN

( No.: +982188912047-9

10a References
Name of company:
Name of person to contact:
Address:

( No.:


11 Sea service

9 Record of previous service
(Please give a full record starting with the last vessel on which you served)












VESSEL FLAG
NAME

I hereby declare that the above particulars are true and authorise you to contact the referees listed above.


In connection with the Law of 29.08.1997 "On Protection of Personal Data" herewith I do agree to the storage and processing my personal data submitted in the company Green Management Sp. z o. o. At the same time I agree to share same with foreign ship owner under the measures aimed at my employment. I am ensured that I have the right to inspect and correct the data.


В соответствии с Федеральным законом РФ от 27.06.2006 №152-ФЗ «О Персональных данных», я даю согласие на обработку, трансграничную передачу и хранение указанных в анкете персональных данных, а также персональных данных, представляемых мною при заключении контракта.
Цель обработки – добавление ПД в базу данных, предоставление вакансий, трудоустройство.


IGOR EFREMOV
Date: 21.05.2018
Signature

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