Engine Cadet
Resume:
Employment Application Form
Personal Details
PHOTO
(passport size)
Position Applied For: Engine Cadet
Available From (date): 20.12.2018
Willing to accept lower rank? Yes X
No
First Name: David
Middle Name: Daniel
Last Name / Surname: Muhin
Nationality / Citizenship:
Latvian
Date of Birth: 03.05.98-10838
Place / City of Birth: Liepaja
Marital Status: Single
Gender: Female X Male
Country of Origin: Latvia
Primary/Permanent Address
Documents / Visas
Number
Place of issue
Issued
Expires
City: Liepaja
Passport
LV5485959
PMLP Liepājas Nodaļa
29.07.2016
28.07.2021
Address: Kuldigas Street 36-11
Seaman’s book (National)
0270727
Latvijas jūrnieku reģistrs Rīgā
16.11.2018
01.09.2022
Post Code: LV-3414
Seaman’s book (LBR)
Country: Latvia
US Visa C1/D
US Visa B1/B2
Nearest Airport: LPX
Schengen Visa
Mobile Tel.: +371********
Home Tel.:
Medical Certificate
VC-21905
Viecliepāja Health Medical Centre
06.11.2018
06.11.2019
E-mail: ******.******@*****.***
Yellow Fever
Nominee/ Next of Kin & Family Details
Full Name: Jadviga Karpova
Relations: Mother
Date of birth: 23.10.1957
Nationality: Polish
Address: Kuldigas Street 36-11
Mobile Phone: +371-*********
Post Code: LV-3414
Country/City: Latvia, Liepaja
Certificate
Number
Date of Issue
Date of Expiry
Place of issue
Basic Oil and Chemical tanker cargo operations
11/18-109
07.11.2018
Unlimited
Libau Training Center
Basic Gas tanker cargo operations
11/18-124
30.11.2018
Unlimited
Libau Training Center
Security training for seafarers
05-05/18
27.11.2018
Unlimited
Liepaja Marine College
Basic safety training
46-08/18
22.10.2018
22.10.2023
Liepaja Marine College
Sea Experience: (Last 10 years; Start the listing below with the most recent experience)
Company
Flag
Vessel Name
Type
GRT
DWT
Main Engine
BHP
Rank
Date From(dd/mm/yy)
Date To (dd/mm/yy)
Reason of Sign off (1)
(1) Reason for Sing Off - e.g. “EOC – End of Contract”, “MED – Medical Ground”, “OWN – Own request”
Please provide details of two recent employers who we may contact for references
Name of Company
Contact person
Address
Phone/E-Mail
Please answer the following questions:
Did you suffer, or presently suffer from any disease likely to render you unfit for services at sea or likely to endanger the health of other persons on board?
If yes, please provide details
YES X NO
Did you suffer any accident, which rendered you temporary and/or partially disabled?
YES X NO
Did you ever undergo psychiatric treatment?
YES X NO
Are you addicted to alcohol or drugs of any kind?
YES X NO
I hereby declare that the above facts and information are true and accurate. I understand that this data will be stored in the Managers’ database for the purposes of my current or future employment arranged by the Managers. Further, I confirm that the above may involve the transfer of my personal data within the Managers’ organization.
Place: Date: Signature:
Contact this candidate