Position applied for SEAWHALE CO LTD

Date of availability ARKHANGELSK, RUSSIA

Crew Application
PART I. PERSONAL DESCRIPTION AND INFORMATION:
1. LAST NAME 2. FIRST NAME 3. MIDDLE NAME 4. DATE AND PLACE OF BIRTH

5.ADDRESS RUSSIA, 6. TEL./FAX 7. CONT. TEL.

8. NATIONALITY 9. HEIGHT 10. WEIGHT 11. COLOUR OF EYES 12. COLOUR OF HAIR

RUSSIA
13. MARITAL STATUS 14. № OF CHILDREN 15. NEXT OF KIN (Name, Relationship)

16. ADDRESS AND TELEPHONE OF PERSON NAMED IN 15 (if same as 5, write "the same")
Address: THE SAME Tel: THE SAME
PART II. PASSPORTS:
DOCUMENT DOCUMENT № PLACE ISSUED DATE ISSUED EXPIRY DATE
Russian Seamans Passport
Travel Passport
Civil (National) Passport
PART III. VISAS:
DOCUMENT DATE ISSUED EXPIRY DATE DATE ISSUED EXPIRY DATE
Valid Schengen Visa
Valid German visa
Valid USA Visa
PART IV. NATIONAL LICENSES:
DOCUMENT GRADE DOCUMENT № PLACE ISSUED DATE ISSUED EXPIRY DATE
Certificate of Competency
Endorsement (TANKER)
Certificate of Competency
PART V. CERTIFICATES:
CERTIFICATE DATE ISSUED DATE EXPIRED CERTIFICATE DATE ISSUED DATE EXPIRED

Basic Training (SOLAS Certificate) ARPA

Proficiency in Survival Craft Radar Observer
Advanced Fire Fighting Tankerman oil Familiarization
Medical First Aid (specialized) Tankerman oil Advanced
Medical Care Bridge Team & Resource Management
GMDSS Ship Security Officer course
Endorsement of GMDSS (date of validy) English course
PART VI. MEDICAL EXAMINATION:
DATE ISSUED EXPIRY DATE DATE ISSUED EXPIRY DATE
Medical Examination
Yellow Fever
PART VIII. REMARKS:
IF YOU HAVE CERTIFICATES THAT IS NOT INDICATED IN PART V. PLS INSERT DATA HERE:
CERTIFICATE DATE ISSUED DATE EXPIRED
1 Salary expectation?
2
3
4
5
6
 PART IX. FOREIGN DOCUMENTS:
GIBRALTAR
No Date of issue Date of expire Capacity
License
Date of Applying X

ANTIGUA & BARBUDA

No Date of issue Date of expire Capacity
Seamans Book
License
GMDSS
Medicine
Date of Applying X
MADEIRA
No Date of issue Date of expire Capacity
License
Date of Applying X
NETHERLANDS ANTILLES
No Date of issue Date of expire Capacity
Seamans Book
License
Date of Applying X
GERMANY
No Date of issue Date of expire Capacity
Seamans Book
License
GMDSS
Medicine
Date of Applying X
LIBERIA
No Date of issue Date of expire Capacity
Seamans Book
License
Solas
Surv.crafts
Medicine
Date of Applying X
CYPRUS
No Date of issue Date of expire Capacity
Seamans Book
License
Date of Applying X
ST. VINCENT
No Date of issue Date of expire Capacity
License
Date of Applying X
 PART X. SEA SERVICE: List and submit proof of sea service during the last 10 (ten) years
PERIOD OF SERVICE
NAME OF CREWING AGENT/
RANK NAME OF VESSEL Vessel Type Engine Type DWT Kilowatts FLAG
SHIPPING COMPANY 2001 2002

AB'S JULIETTA GOD 5600 7406 A&B ASKOLDAS INTERNATION 2003 2003 09 21

ASKOLDAS INTERNATION 2004 2005 02 21

LIMITED COMPANY

OILER ATLANTIC DOWN FACTORY _____ ____ _____ IRELAND NOVIKONTAS LIMITED CO 2003 04 2008 10 01

OS SEAMAN

AB'S

COOK

PART XI. NAUTICAL, ENGINEERING OR RADIO SCHOOL AS ATTENDED:

Dates attended Type of degree of Diploma received upon
Name of School Address Graduation
From To

MARINE COLEGE KLAIPEDA LITHUANIA 2002 2005 PORT OPERATION DEPRTM.

EUROPEAN LEVEL

2009 8:38 OLEG MURE NKOV NIKO

Date Name, Signature of Seafarer