Моторист

Описание

Position apply forType of Vessel
PERSONAL DETAILS
Surname Фамилия Date of birth
First Name Имя Citizenship
Middle Name Отчество Gender
Place of birth Место рождения Civil status
Religion
PERMANENT ADDRESS
Street Улица
House Flat Comments
City
Country Регион
Airport Post code
REGISTRATION ADDRESS
Street Улица
House Flat Comments
City
Country Регион
CONTACT DETAILS
Primary Mobile Number Secondary Mobile Number
Home Phone E-mail
NEXT OF KIN / BENEFICIARY
Surname First name Middle name
Birthdate Gender
Street Relation
House Flat Mobile
City Phone (Home)
Country E-mail
LIST OF CHILDREN (UP TO 21 AGE)
Surname First name Middle name
Relation Birthdate Gender
Surname First name Middle name
Relation Birthdate Gender
Surname First name Middle name
Relation Birthdate Gender
PHYSICAL DETAILS
Height cm Hair colour Uniform size Weight kg Eyes colour Shoes size
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178 GREY 58 80 GREY 42
KORNEV YURA
Son 14.02.2016 MALE
RUSSIAN FEDERATION
KORNEV ARTUR
Son 04.10.2004 MALE
ENTUSIASTOV Brother
17 53 +79214555660
PETROZAVODSK
sergeykornew@mail.ru
KORNEV ALEKSANDR
04.09.1984 MALE
3 67
MURMANSK
RUSSIAN FEDERATION МУРМАНСКАЯ ОБЛ.
89537506291 +79600293066
МУРМАНСК/MURMANSK
RUSSIAN FEDERATION МУРМАНСКАЯ ОБЛ.
MMK Murmansk
PR-D SVYAZI ПР-Д СВЯЗИ
183025
Christian
PR-D SVYAZI ПР-Д СВЯЗИ
3 67
MURMANSK МУРМАНСК/MURMANSK
- Юрьевич MALE
ГОР.СОРТАВАЛА РЕС.КАРЕЛИЯ Divorced USSR
APPLICATION FORM
KORNEV Корнев 24.02.1979
SERGEI Сергей RUSSIAN FEDERATION
Comments / Комментарий
Page 1
MotormanBULK CARRIER
Photo
Please let us know how you heard about our company / Как Вы о нас узнали? Нашел через поиск в интернете

NATIONAL IDENTITY DOCUMENTS / VISA
Civil Passport Series No Issued Authority
Foreign Passport Series No Issued Expiry Authority
Seafarer's ID Series No Issued Expiry Authority
Seaman's Book Series No Issued Authority
USA VISA Issued Expiry Visa Type Issuing Post Name
Shengen VISA Issued Expiry No. of Visa Issuing Post Name
EDUCATION
42 МШ г.КРОНШТАДТ.МУРМАСКИЙ ИНДУСТРИАЬЫЙ КОЛЛЕДЖ.
CERTIFICATE OF COMPETENCE
NATIONAL DOCUMENTS (ENDORSMENTS)
TRAINING COURSES
Page 2
Comments
Comments
Comments
Comments
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4724 839168 03.04.2024 УМВД РОССИИ ПО МУРМАНСКОЙ ОБЛ.
76 4947334 07.07.2021 07.07.2031 МВД 51006
RUS 0530379 11.11.2021 10.11.2026 Harbour Master - Murmansk
МК 0004426 07.04.2011 Harbour Master - Murmansk
NAME OF (MARITIME) EDUCATIONAL INSTITUTION PERIOD SPECIALISATION Grade Issued On FROM TO 02.09.1996 01.07.1997 МОТОРИСТ 1КЛ Technical College 20.06.1997 ЭЛЕКТРИК 1КЛ Technical College 15.05.2014
TYPE INSTITUTE NUMBER PERIOD ISSUED EXPIRY
Able seafrer engine Harbour Master - Murmansk ММК 205177162 08.10.2021
TYPE AUTHORITY NUMBER PERIOD ISSUED EXPIRY
TYPE INSTITUTE NUMBER PERIOD ISSUED EXPIRY Basic Safety Training Murmansk branch of Admiral Makarov State University 1799929 22.06.2021 22.06.2026 Basic Training for oil and chemical tanker cargo operation UTCSB-Uchebny Trenirovochny Centre Severnogo Bassejna 1683894 01.02.2022 01.02.2027 Security Training for Seafarers with designated security duties Murmansk branch of Admiral Makarov State University 1850343 27.07.2021 27.07.2026 Proficiency in Survival Craft Other than Fast Rescue Boat Murmansk branch of Admiral Makarov State University 1923216 04.04.2022 04.04.2027 HAZMAT (For Vessels Carrying dangerous and hazardous substances in solid, bulk or in packaged form) «MARSTAR» Non-State Educational Institution 697-114/23-05С 25.04.2023 25.04.2028
APPLICATION FORM

SEA SERVICE (Complete sea service record for the last 10 years with the most recent record last)
PREVIOUS EMPLOYER'S DETAILS FOR REFERENCE
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APPLICATION FORM
Trans-Group SPb Ltd
Person in charge
отделаперсонала.
+79812453926 Елена ВикторовнаРуководитель
Company Name Telephone E-mail
24.09.202511.11.2024 TG ARKTIKA BULK CARRIER 23645 B&W 9473 RUSSIAN FEDERATION Trans-Group SPb Ltd Motorman 22.03.2025
07.03.2024 TG ARKTIKA BULK CARRIER 23645 B&W 9473 RUSSIAN FEDERATION Trans-Group SPb Ltd Motorman 24.07.2024
01.09.2023 TG ARKTIKA BULK CARRIER 23645 B&W 9473 RUSSIAN FEDERATION Trans-Group SPb Ltd Motorman 07.12.2023
03.03.2023 TG ARKTIKA BULK CARRIER 23645 B&W 9473 RUSSIAN FEDERATION Trans-Group SPb Ltd Motorman 31.05.2023
19.09.2022 TG ARKTIKA BULK CARRIER 23645 B&W 9473 RUSSIAN FEDERATION Trans-Group SPb Ltd Motorman 08.12.2022
10.11.2021 GOGLAND REEFER 6640 B&W 7250 RUSSIAN FEDERATION ACHEON SHIPPING W EST Motorman 07.04.2022 ISKATEL-5 SEISMIC ZULZER 2300 RUSSIAN FEDERATION SMNG Motorman
11 PR.RYABINKIN SEISMIC 952 W ARTSILA 1520 RUSSIAN FEDERATION SMNG Motorman 09.01.2014
To
1 2 3 5 6 7 8 9 10
Page 3
Name of vessel Vessel Type Deadweight Engine Type Engine Power (kW) Flag Management Company or Crew Agent Rank From

Page 4
Applicant's name:
MEDICAL HISTORY
Had you ever been signed off sick?
Name of vessel
Had you ever been operated?
Date
Date
29.10.2025
Rank
Type of ship
Date
Name of Crewing manager
Signature of Crewing manager
APPLICATION FORM
No
Place Confirmation
29.10.2025 Мурманск I confirm
Date
Настоящим Яподтверждаю, что все вопросы данной анкеты мне понятны. Ягарантирую, что ни один из
моих сертификатов не был обьявлен недействительным, действие ни одного из сертификатов не было
приостановлено ини один из них не был подделан, иЯ ответил правдиво на все вопросы сучетом
известной мне информации.
Authorization for pre-employment process:
Manager's notes
Iagree with the automated processing ofmy personal data specified inthe questionnaire, with their transfer and storage for employment purposes
С автоматизированной обработкой моих персональных данных, указанных в анкете, сих передачей и
хранением в целях трудоустройства согласен
Agreement
I agree
Brief description of surgery
Seafarer's obligation
Iherewith confirm that all the questions provided with this application form are clear to me. Iguarantee that no any of my certificates has ever been revoked, suspended or faked-up and Ianswered truthfully to all the questions to the best of my knowledge.
If yes, please provide following details
Please advise details of any injury and/or health problem during last 10 years:
IT IS VITAL THAT ALL ILLNESSES AND/OR INJURIES EXCEPT OF MINOR AFFECTIONS ARE DECLARED.
If yes, please provide following details
Date Brief description of illness, injury, accident
No