GOLF MARINE LIMITED

47/3, Marshala Zhukova Ave.

Ave., Office 23,
23, Odessa,65114,
Odessa,65114, Ukraine
Tel:
Tel: +380-482-324540;
+380-482-324540; +380-482-324539. Fax: +380-482-324538
E-mail: crew@gmarine.com.ua

web : www.gmarine.com.ua

Application for Employment

20.05.2012
600

Date Available:
Position Desired: Deck cadet
Name:

Petrenko

Salary Desired:

Taras

(Family Name)

08.05.1991

D.O.B.:

Sergiyovich

(First Name)

P.O.B.:

Age:

Izmail

Nationality:Ukranian

Home address : Izmail, Lenina av. 10/1, ac. 115

Weight : 74__ Height/Overall : 183____ Shoes : 43

Mobile: 0939423681

E-mail : groovein@yandex.ru_ Skype : groove_in

Sex :
Marital status:
Male

Tel:
Spouse :
Tel.:0503911020

Single

Next of kin: Petrenko Ira Nikolaevna, mother

(Give full name and relationship)

Travel Passport: EK791129

Seamans Book: AB432895

Date of issue: 22.02.2010

Date of issue: 12.02.2010

Valid until: 22.02.2020

Valid until: 12.02.2015

(Copies should be attached)

209590U - 16.10.2014

Basic Safety Training:

(Copies should be attached)

(serial number - expiry date)

Firefighting
Certificate:
(Copies should be

(Copies should be attached)

(serial number - expiry date)

GMDSS Endorsement:
(Copies should be attached)

English Status :

Good

From:
To:

14.07.2011
18.10.2011

From:
To:

Vessel Name
Flag

Portoviy 5
Ukraine
Bozhenko
Ukraine

(serial number - expiry date)

(Copies should be attached)

(last five years)

Company Name Vessel Type(1)

Crewing Agency
DWT

Engine (2)
HP

UDP

tug

126

UDP

bulk
2588

(2)

Rank

Deck cadet

GOTAWERKEN/MAK/MAN-B&W/SULZER/MITSUBISHI/PIELSTICK/STORK

To be filled out by Crewing Manager

References:
Comments:
Planned for M/V:
Agreed Salary:

Applicants name & signature:

GOLF MARINE LTD Application for Employment/ REV 05

Reason of
Discharge

Deck cadet

Bulker/General/Container/Logger/Passenger/RO-RO/Reefer/Tanker

Date:

(serial number - expiry date)

Poor

Employment History
Dates
Months/Year
From: 27.07.2010
To:
29.09.2010

(serial number - expiry date)

Radar & ARPA Cert.:

(expiry date)

Moderate

(Copies should be

(serial number)

Medical First Aid/Care:

Survival Craft Certificate:214848U 14.10.2014

(1)

(expiry date)

Endorsement valid
until:

License No & Grade:

From:
To:

USA Visa:

ONMA, 4th course

Education:

From:
To:

21

(Father Name)

I hereby confirm that above information is true and correct to the best of my knowledge. I understand that this information will be held in the computer database due to my real or possible employment. Signing it, I willfully give
my permission to collect and process my personal information and to use it in all and any legal way. I give my
permission for my personal information to be provided to the possible employers and any other persons, if such
need arises from my employment. Besides, I permit the Golf Marine ltd. employees to request personal information (data) about me from my former employers.
, , . ,
.
,
, .
, , ,
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To be filled out ( by Crew Inspector)

Comments:

Date:

Applicants name & signature:

GOLF MARINE LTD Application for Employment/ REV 05