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Applicant'S Personal Data: Seastar@

This document contains an application for employment as a maritime agency. It includes sections for the applicant's personal details such as name, address, education history, licenses and certifications held, past work experience including ship details, and a statement authorizing the automatic processing of personal data. Medical certificates and documents such as a seaman's passport and licenses are also listed.

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Iuri Dudinov
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59 views1 page

Applicant'S Personal Data: Seastar@

This document contains an application for employment as a maritime agency. It includes sections for the applicant's personal details such as name, address, education history, licenses and certifications held, past work experience including ship details, and a statement authorizing the automatic processing of personal data. Medical certificates and documents such as a seaman's passport and licenses are also listed.

Uploaded by

Iuri Dudinov
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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SEA STAR LTD Maritime agency

353905, Tolstogo 4, office 401 Novorossiysk, RUSSIA. Phone/fax: (8617) 72-02-00,


mob:+7 918-648-39-37. E-mail: [email protected]/ License 20105230827
APPLICANT’S PERSONAL DATA
POSITION APPLIED FOR DATE:
FIRST/LAST NAME : MARITAL STATUS :
FATHER’S NAME : NUMBER OF CHILDREN :
DATE/PLACE OF BIRTH: NEXT KIN :
USSR RELATION :
CITIZENSHIP : RUSSIAN NEXT KIN ADDRESS :
ADDRESS :
PHONE :
E-MAIL : MOTHER NAME:
PHONE: PHONE :
MARINE EDUCATION RECEIVED
NAME OF SCHOOL FROM TILL TYPE OF DEGREE RECEIVED

DOCUMENTS NO. Place of issue Date of issue/validity


SEAMAN’S PASSPORT
TRAVELLING PASSPORT
OTHER S/B LIBERIAN
VISA USA
SERTIFICATE GRADE NO. Place of issue Date of issue/validity
NAT.LICENCE :
ENDORSEMENT :
OTHER:
LICENCES :
GMDSS :
ENDORSEMENT :
BRIDGE TEAM MANAG.
Shipshandling and Manoeuvring
ELCARDS AND DISPLAY
RADAR OBSERVER :
ARPA :
STCW
ADVANCED FIRE FIGHTING : A-VI/3
PERS.SAFETY AND SOCIAL RESPONS : A-VI/1-4
PROFICIENCY IN SURVIVAL CRAFT,RESCUE
BOATS : A-VI/2-1
TANKER CERTIFICATE :
CHEM.TANKER CERTIFICATE :
COW / IGS
LPG CERTIFICATE
HAZMAT
SHIP SECURITY OFFICER
FIRST AID CERTIFICATE : A-VI/4-1
MEDICAL CARE CERTIF. : A-VI/4-2
HEALTH CERTIFICATE :
ADC VACCINATION :
YELLOW FEWER :
SIZES : ENGLISH:
CLOTHES SHOES HEIGHT WEIGHT POOR SATISFACTORY MODARATE GOOD EXELLENT

VESSEL’S NAME COMPANY FLAG VSL’S TYPE DWT ENGIN BHP RANK EPLOY MENT
M/Y M/Y

SALARY: TERMS OF READINESS CES 4.1 :


ADDITIONAL INFORMATION ABT PREVIOUS EMPLOYERS (ADDRESS,TEL/FAX/TLX/E-MAIL,CONTACT PERSON):
С автоматической обработкой моих персональных данных, указанных в анкете, включая их передачу третьим лицам на территории РФ и за ее пределами,
их хранением в целях трудоустройства, в соответствии с Федеральным Законом РФ № 152 от 27.07.2006 г.
Подтверждаю, что мои персональные данные, указанные в анкете, являются общедоступными.

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