APPLICATION FORM
Rank: *rd Officer Date: **.**.2020
PERSONAL DETAILS
Surname
Kudriavtcev
First Name Nikolai
ID N/A
Date of Birth
29.09.1994
Place of birth Saint-Petersburg, Russia
Citizenship & Nationality Russian Federation / Russian
Address
146 apt., 18/1 Verbnaya Str., Saint-Petersburg, Russia
Tel. No.
Mob. Tel. No. +795********
adjurl@r.postjobfree.com
Weight: 70kg
Height: 170cm
Hair: Brown
Eyes: Green
Shoes: 42
Parka: 48
Overall size: 48
CONFIDENTIAL INFORMATION FOR OFFICE USE ONLY
Name of next of kin Arina Kudriavtceva
Relationship Wife
Contact telephone +795********
Address of next of kin 146 apt., 18/1 Verbnaya Str., Saint-Petersburg, Russia
Number of Children / Sex
2 / Male
Civil status
o Single o Married o Divorced
GENERAL DETAILS
GENERAL DETAILS
Document
Number
Date and place of Issue
Date of Expiry
Passport
75 2835388
17.02.2016/Saint-Petersburg
17.02.2026
Seaman's Book
0110018
05/11/2013/ Saint-Petersburg
Lifetime
Other
Schengen Visa
016320928
16.12.2020/ Moscow
16.12.2022
USA Visa
1834866
27.04.2018 / Vilnius,Lithuania
25.04.2020
International Medical Certificate
15.06.2020/ Saint-Petersburg
15.06.2021
Other (Yellow fever)
19.05.2014/ Saint-Petersburg
Lifetime
CERTIFICATES/QUALIFICATIONS
Type/Grade/Class
Number
Date and place of Issue
Date of expire
Country
Navigation
LED201178916
10.07.2017/Saint-Petersburg
03.02.2022
Russian Federation
Radiocommunications
LED201178942
10.07.2017/Saint-Petersburg
23.03.2022
Russian Federation
SEA SERVICE (Last five years)
Name of Vessel
Type
Flag
GT/KW
Type оf Main Engine
Employer
Rank
Date From dd/mm/yy
Date To dd/mm/yy
Stolt Effort
Oil/chemical tanker
Cayman Islands
24509/10000
Wartsila diesel electric
STOLT TANKERS B.V.
3RD OFFICER
24/06/2020
15/11/2020
Stolt Effort
Oil/chemical tanker
Cayman Islands
24509/10000
Wartsila diesel electric
STOLT TANKERS B.V.
3RD OFFICER
20/10/2019
01/02/2020
Stolt Efficiency
Oil/chemical tanker
Cayman Islands
24625/10000
Wartsila diesel electric
STOLT TANKERS B.V.
3RD OFFICER
24/01/2019
26/05/2019
Stolt Inspiration
Oil/chemical tanker
Cayman Islands
24625/10000
Wartsila diesel electric
STOLT TANKERS B.V.
3RD OFFICER
11/05/2018
26/09/2018
Stolt Fulmar
Oil/chemical tanker
Cayman Islands
3818/2760
Wartsila diesel electric
STOLT TANKERS B.V.
DECK TRAINEE OFFICER
18/09/2017
15/01/2018
Stolt Capability
Oil/chemical tanker
Liberia
24625/10000
Wartsila diesel electric
STOLT TANKERS B.V.
Deck Cadet
17/10/2016
17/01/2017
Stolt Fulmar
Oil/chemical tanker
Cayman Islands
3818/2760
Wartsila diesel electric
STOLT TANKERS B.V.
Deck Cadet
6/05/2016
10/08/2016
EDUCATION AND CURRENT EMPLOYMENT
Date From
Date To
Schools, Colleges
Exams Passed - Certificates Obtained
01/09/2012
30/06/2017
Admiral Makarov State University of Maritime and Inland Shipping
National diploma
Date From
Date To
Ashore work
Employer's Name and Address
01.02.2016
10/12/2020
Stolt Tankers B.V., Westerlaan 5, 3016 CK, Rotterdam, the Netherlands
DETAILS OF COURSES ATTENDED
Type of Training
Date of issue and Certificate No
Type of Training
Date of issue and Certificate No
Personal Survival Tech.
Chemical Tanker Basic
674-342/20-07C/ 09.12.2020
Basic Fire Fighting
Chemical Tanker Advanced
0626178/30.08.2017
Elementary First Aid
Gas Tanker Basic
670-349.20-01С / 16.12.2020
Personal Safety & Social Responsibilities
Gas Tanker Advanced
Survival Craft Prof.
0785636/07.07.2017
Crowd Management
Advanced Fire Fighting
0751834/28.04.2017
Ro-Ro Passengers Familiarization
Radar Observer
0787375/10.03.2017
Safely Training in Service To Passengers Space
Medical First Aid
0752315/23.03.2017
Pass. Safety, Cargo Hull Integrity
Medical Care
Crises Management
ARPA
0787773/16.03.2017
ISM Code Training
GMDSS
LED201178942/10.07.2017
Basic Safety Training
0784946/24.04.2017
R/T
Security Training
0752807/04.04.2017
Fast Rescue Boats Prof.
ECDIS Course (Generic)
0788197/03.02.2017
Practical Ship Handling
06013/18 09.02.2018
Bridge Resource Management
09/2018 28.02.2018
HAZMAT
ECDIS Course (Furuno FMD)
2018-00666/23.01.2018
Crude Oil Washing
Oil Tanker Basic
674-342/20-07C/ 09.12.2020
Oil Tanker Advanced
0625916/18.08.2017
KNOWLEDGE OF LANGUAGES
Language
Speaking
Reading
Written
VG
G
S
F
P
N
VG
G
S
F
P
N
VG
G
S
F
P
N
English
X
X
X
REFERENCES
Name of Company
Address and Phone
Person in charge
I HEREBY DECLARE THAT THE ABOVE IS TRUE.
Date 15.12.2020 Signature Kudriavtcev