Application Form for Seafarers_General Template

EMPLOYMENT APPLICATION FORM

Rank: 2nd officer/Chief officer

Date Available for Joining: APRIL

Vessel:

Personal details

Surname: Popov

First name: Dmytro

Photo:

Date of birth: 06.09.1988

Place of birth: Ukraine, Odessa

Nationality: Ukrainian

Home address: Ukraine, Bocharova str 56 app 42 (Romania, Bucharst - temporarily)

Phones: +380*********

Nearest airport: Bucharest international airport

Nearest international airport: Bucharest international airport

Documents

Passport No.

FE635508

Issued on:

22.06.16

Expiry date:

22.06.26

S/book No.

AB671023

Issued on:

01.12.20

Expiry date:

01.12.25

US visa C1/D

202***********

Issued on:

27.02.20

Expiry date:

25.02.30

Сanada visa

E738154929

Issued on:

02/02/2023

Expiry date:

21/06/2026

LICENCE PARTICULARS

MOT

Grade

Cert No

Place of Issue

Date of Issue

Expiry date

National License

22798/2024

Ukraine,Odessa

11.03.24

Endorsement

22798/2024

Ukraine,Odessa

11.03.24

06.03.29

Tanker endorsement

Crude Oil

Liquid chemical

Liquefied gas

Belgium S/book

202000654

Antwerp

03.06.20

CERTIFICATES

Cert No

Date of Issue

Expiry date

G.M.D.S.S.

05957/2023/08

11.07.23

G.M.D.S.S. Endorsement

05957/2023/08

11.07.23

07.07.28

Proficiency In Survival Craft

20313

20.03.24

20.03.29

Basic Safety Training

10311

20.03.24

20.03.29

Advanced Fire Fighting

30297

20.03.24

20.03.29

Dangerous And Hazardous Substances

03946

06.07.23

06.07.28

ROP/ARPA

230067

20.03.24

20.03.29

Ship Security Officer

200142

20.03.24

20.03.29

Medical First Aid

40237

20.03.24

20.03.29

DP Induction Course

DP Advanced Course

DP Unlimited Certificate

Leadership and Teamwork

1530012

20.12.22

20.12.27

Bridge Resourse Management

260096

20.03.24

20.03.29

ECDIS

250115

20.03.24

20.03.29

ECDIS Type Specific TRANSAS

MYCERTM00120Y4VILG0FY5

12.02.21

11.02.26

ECDIS Type Specific FURUNO

2017-04959

20.06.17

ECDIS Type Specific SAM ELEC.

MYCERTM00120YHWC45WU77

27.05.22

ECDIS Type Specific CONSILIUM

SID71596U/90407

20.10.16

ECDIS Type Specific JRC

Medical examination (Belgium, Liberia)

04.07.2023

04.07.2025

Yellow fever

03.06.20

03.06.30

Pre-SEA Training / Nautical School / Maritime School

Qualifications

Passed:

MARITIME COLLEDGE OF TECHNICAL FLEET, ONMA

Navigator

2005

KHERSON STATE MARITIME ACADEMY

BACHELOR OF NAVIGATION

2016

KHERSON STATE MARITIME ACADEMY

SPECIALIST OF NAVIGATION

2021

SEA SERVICE

Name of Vessel

Year

Built

Flag

Type of Vessel

and Engine (Type)

DWT

Rank

Period of Service

Name of Company

HYUNDAI PARAMOUNT

2013

Liberia

Container

63010

2nd Officer

30.08.23

18.01.24

Capital Executive

CMA CGM ORFEO

2008

Germany

Container

120892

2nd Officer

04.02.23

06.05.23

Claus Peter Offen

Conti Cortesia

2005

Malta

Container

106912

2nd Officer

03.06.22

02.11.22

Claus Peter Offen

MSC MADRID

2011

Liberia

Container

74375

2nd Officer

02.11.21

23.04.22

Claus Peter Offen

CMA CCM BUTTERFLY

2008

Germany

Container

120933

3rd Officer

19.02.21

17.05.21

Claus Peter Offen

HARPY HUNTER

2009

Belgium

Container

51701

3rd Officer

06.07.20

13.11.20

Claus Peter Offen

MSC CADIZ

2011

Germany

Container

74526

3rd Officer

30.09.19

12.01.20

Claus Peter Offen

CMA CGM ALASKA

2011

Liberia

Container

146000

3rd Officer

05.03.19

02.07.19

Claus Peter Offen

CMA CGM ALASKA

2011

Liberia

Container

146000

3rd Officer

06.06.18

13.11.18

Claus Peter Offen

CPO BREMEN

2009

Malta

Container

103773

3rd Officer

30.09.17

02.04.18

Claus Peter Offen

MCS TORONTO

2006

Germany

Container

105084

3rd Officer

27.04.17

05.09.17

Claus Peter Offen

ALIANCA IPANEMA

2013

Cyprus

Container

45878

3rd Officer

20.09.16

12.01.17

Tomas Schulte

BELLA SCHULTE

2011

Liberia

Container

49891

3rd Officer

19.12.15

29.03.16

Tomas Schulte

References

Exp. with Multinational Crew:

Yes

Name of company:

Nationalities:

Filipino, German, Romanian, Polish, Latvian, Lithuanian

No.

Name of company:

Level of English

Good

No.

Marlins Test %

85

Next of kin

Personal data:

Name/Relationship

Weight, kg:

80

Height, cm:

170

Home address:

Eyes:

Brown

Hair:

Brown

Phones:

Overall size:

52

Safety shoes:

42

About you:

Contact this candidate