Помощник капитана по радиоэлектронике

Описание


SEAFARER’S APPLICATION FORM
Name in full (First, Middle, Last) : Rank : [pic]
Vadim Ivanovich Yakovenko Radio Electronic
Date & place of birth: Nationality:
18.02.1967 Kaliningrad reg. (USSR) Russia
Marital status: Single
Hair / eyes (colour) : grey Height (m): Weight (kg)/ BMI: Safety shoes size: Safety overall size:
1,72 85 42 50-52
Education (name & city of educational institution, dates of entry / graduation and degree):
Kaliningrad Marine College 1984/1989 radio technician
LICENCE INFORMATION (Certificate of Competency/Proficiency):
Country: Grade of Licence: Number: Date issued: Place issued: Expiry Date:
OTHER CERTIFICATES AND ENDORSEMENT INFORMATION:
Certificate/Endorsement STCW Regulation No Number /Type Date issued: Place issued: Expiry Date:
ARPA / Radar A-II/1, A-II/2
ECDIS B-I/12
Bridge / Engine Team A-II / A-III
Ship Security Officer A-VI/6-5
Security Duties A-VI/6-2 AB 0952585 30.01.2018 Kaliningrad 30.01.2023
Basic Safety Training A-VI/1 AB 0949783 02.02.2018 Kaliningrad 02.02.2023
First Aid / Medical care A-VI/4-1 // A-VI/4-2 AB 1056227 05.12.2018 Kaliningrad 05.12.2023
Survival craft & rescue A-VI/2-1 AB 0951155 05.02.2018 Kaliningrad 05.02.2023
boats
Advanced Fire Fighting A-VI/3 AB 1054698 30.11.2018 Kaliningrad 30.11.2023
DP unlimited
DP maintenance course
High Voltage
Huet / Bosiet
SEAMAN’S BOOK, SEAFARER’S ID & PASSPORT INFORMATION:
Seafarer’s ID No: Place & Date Issued: Expiry Date: Travel Passport No: Place & Date Issued: Expiry Date:
Seaman’s Book No: Place & Date Issued: Expiry Date:
VISA INFORMATION:
Visa: Type: Valid Until: Remarks:
USA visa
Schengen Visa POL100227181 MULT TYPE C (23) 29.04.2026
LANGUAGE INFORMATION:
Good Satisfactory Poor Remarks ( Marlins Test (%) , etc.)
English x


Page 1 of 2
RECORDS OF PREVIOUS SEA SERVICE ( for previous 10 years / most recent service must be on the bottom line)
Vessel’s Name / IMO NumberDP class Type of DP system DWT / Rank From To Company
Type and Model of M.E., kW (date-month-year) (date-month-year) (Shipowner /Technical Manager/ Crewing Agency)
F/T "Lira" 7765 Mak 832E 8000 kW Radio electronic 24.05.2021 20.06.2021 Morskaya Zvezda Co LTD
8607294
SV "Ostap Sheremeta" DP2 5035 Wartsila 15000kW Radio electronic 02.2020 09.2020 Gazprom Flot LLC
9624225
F/T "Soley" 7765 Wartsila 6M32C 5296 kW Radio electronic 12.2016 12.2019 Levert Shiping Co LTD
8607270
DP1 1788 MAK 2X8M25 5280 kW Radio electronic 04.2013 06.2016 Global Flot LTD
SV "Vzmorye" 9380192
2897 MAK 2X8M20 2720 kW Radio electronic 10.2011 12.2012 Gaztechleasing LTD
TN "Gazpromshelf" 9353058
F/T "Geysir" 7805 Wartsila 16V 32D 5920 KW Radio electronic 08.2006 06.2011 Katla Seafood LTD






REMARKS (Availability for service; Dry Dock experience; other languages; mix crew experience; other, etc.):
I hereby confirm that all the information provided by me in this form is true and correct.
Date: 08/09/2021
Signature of Seafarer:

References:
Company (Crewing or Shipowner) / Contact person (Superintendent, Manager, Captain, Chief Engineer or other person/ Telephone number):
________________________________________________________________________________________________________________________