Date of applicati

Application Form for Seafarers

RANK: Oiler

Surname Merinovskii photo

First name Nikita

Date of birth: 2/15/1991

Place of birth: Primorskii kray, Nakhodka

Marital Status: single

Home Address: Nakhodka, michurina str 10-18

Home Phone/Fax/e-mail Height:

8-423*-**-**-**-***

Mobile telephone Weight:

8-914-***-**-**-**

Next Relations And Kin’s/Name/Phone Clothes size

Mother, Merinovskaya Larisa (same adress and phone 56

number)Marlins Test Other test:

Language / Knowledge Shoes size 43

CES

Result: Result:

( English ) Hair color

Other language Speaking: Writing: Eye color gre Academic Qualification Name of Institution: Qualification: Year of graduation:

MSU named after G.I.Nevelskoy Engineer 2016

Details of License and Seafarers GRADE NUMBER ISSUED EXPI

Documents

Identity-/Travel Documents

Seaman’s Passport RUS 0115670 8/28/2012 8/27/2

Travel Passport 71-660****-**/20/2010 10/20/2

Seaman’s Book: (if applicable) MK 0097698 8/29/2012

US visa C1/D 716-***-**** 4/22/2014 4/17/2

Medical Certificates

Physical Examination 4/16/2

Yellow Fever Vaccination 4/16/2013 4/16/2

Certificates - courses

Certificate of Competency RATING FORMING PART OF AN ENGINE ROOM

305-***-**** 11/26/2012

Medical First Aid 362751 8/3/2012 8/3/20

Advanced Fire-fighting 362751 8/3/2012 8/3/20

Marpol/Solas 001417 7/30/2012 7/30/2

Proficiency in survival craft, rescue boats 299392 8/7/2012 8/7/20

Personal survival techniques 362751 8/3/2012 8/3/20

Tanker Certificates

Tanker Endorsement STCW 95 Oil/Chem/Gas

Oil-Tanker Familiarization Course 225153 8/10/2012 8/10/2

Crude oil washing/Inert Gas/Specialized

Chemical Tanker Familiarization Course

Specialized Chemical Tanker Training Prg.

Liquefied gas-tanker familiariz. course

Specialized liquefied gas tanker train.prg

Specialized oil tanker training 225052 17.08.2012 17

Sea-Service

FROM TO RANK NAME OF VESSEL TYPE OWNER DWT M/E T

15/06/06 23/07/06 CADET ANGARSK TANKER PRISCO 3086 PIELSTICK

09/07/10 09/07/11 OILER VARSHAVIANKA SUBMARINE RUSSIAN NAVY 3950 BRYANSK

25/05/12 27/07/12 OILER/CADET OSTAS N

K BULKER AQUAMARINE LTD. 35971 MITSUBISH

26/04/13 24/12/13 OILER ASIAN ATLAS HEAVY LIFT VIATECH ENGINEERING LTD. 38571 MAN B&W

24/05/14 09/07/14 OILER BRAVANTE VII PSV BRAVANTE 3200 CUMMINS

ication

178

85

56

43

grey

:

6

XPIRY

27/2017

/20/2021

17/2016

16/2015

16/2023

/3/2017

/3/2017

30/2017

/7/2017

/3/2017

10/2017

17.08.2017

/E TYPE

TICK

NSK

BISHI

&W

INS

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