Medical Engineer
Resume:
Application Form
Section *
Position
Position Applied for
Able seaman
Lowest Position Acceptable
Ordinary seaman
Date of Availability
** / ** / **** **/**/yyyy
Section 2
Personal Details
Family name / Surname
Kalinin
First Name / Given Name
Ilya
Date & Place of Birth
Date - 09.09.1993 Place- Tolyatty, Samara region
Nationality
Russian
Permanent Address
Russia.Rostov-on-Don, Sholokhova pr. 140/2, 40
Present Address
PPE information
SAFETY SHOES SIZE
45
COVERALL SIZE
57
Blood Group Information
Present Contact Number
Mobile Number
SKYPE ADDRESS
Kalinin90909
Email Address
***************@****.**
Nearest Airport (and Distance)
Rostov-on-Don (5km)
Section 3
Passport and VISA details
Country of Issue
Russia
USA Visa - Type
B1/OCS
Date Issued
08.06.2010
USA VISA Expires
Place Issued
ФМС 23006
USA Visa - Type
C1/D
Passport Number
71 1111245
USA VISA Expires
Passport –Expires
08.06.2020
Other Country Visa
Secondary passport or Dual nationality
Visa Expiry
Section 4 ( hi-light as required )
Seaman book / Discharge book / Seaman Record Book / CDC
Issuing Country & Place
Russia
Date Issued
04.05.2011
Number
RUS 0017474
Expiry Date (if any)
03.05.2016
Section 5
Next of Kin – this is important information we require- Don’t ignore it
Full Name / Relationship
Kalinina Irina. Mother
Any dependents / Children (incl age )
Address
Russia,Krasnodar region,Yeisk, Yasenskaya str. 23,88
Contact Numbers
Page 1 of 7
Section 6 STCW95 Highest Certificate of Competency / Licence Held ( also list Flag State Endorsements)
Class / Grade/Capacity
Issuing Country
Certificate No.
Date Issued
Expiry
Details of Limitations
Training of seafarers with designated security duties
ALSO ENTER ABOVE DETAILS OF ANY OTHER FLAG STATE CERTIFICATES HELD
Section 7 STCW95 Dangerous Cargo Endorsements
Petroleum
Liquefied Gas
Liquid Chemicals…….
Certificate No.
Date Issued
Expires
Details of Limitations/ Grade
Section 8 STCW95 related Courses Attended and Certificates Obtained
Name of Course / Certificate
STCW Code
Place
Issue Date
Cert No
Expiry Date
Basic Safety Training
A-VI/1
Russia
31.07.2015
0179884
31.07.2020
Basic Sea Survival / Personal Survival Techniques
A- VI/1-1
Fire Prevention & Fire Fighting
A-VI/1-2
Elementary First Aid
A-VI/1-3
Personal Safety & Social Responsibility
A-VI/ 1-4
Proficiency in Survival Craft & Rescue Boats
A-VI/ 2-1
Russia
29.07.2015
0258904
29.07.2020
Proficiency in RESCUE CRAFTS
Proficiency in FAST RESCUE BOATS
A-VI/ 2
Advanced Fire Fighting
A-VI/ 3
Medical & First Aid
A-VI/ 4-1
Medical Care
( Ship Captains Medical Course )
A-VI/4-2
Radar & ARPA Simulator Trg- Management level
A-II/ 1-2
Electronic chart Display and Information System course (ECDIS)
A-II / 1
GMDSS + ENDORSEMENT
A-IV/ 2
SAFETY OFFICERS COURSE (SO)
Ship Security Officers Course (SSO)
Issued under STCW95
A-VI/ 5
Proficiency in Security Awareness
A-VI/6
Proficiency in Designated Security Duties
A-VI
Russia
28.07.2015
0023017
28.07.2020
Medical Certificate / HEALTH Certificate
MLC Compliant
Drug and Alcohol test certificate
YELLOW FEVER
Russia
31.08.2013
31.08.2023
Bridge Team Management
A-II/2
Bridge Resources Management
B-VIII/2
ISM Code
A.1441 (18)
TANKERS FAMILIARISATION
A-V/1
Advanced Tanker Operations (Chem.)
A-V/1-2
Advanced Tanker Operations (Oil)
A-V/1
Advanced Tanker Operations (LPG)
A-V/1
REFRESHER & UPDATING
I/II & III/2
Page 2 of 7
Section 9 OFFSHORE INDUSTRY COURSES
Please enter below any other certificates held or courses done, ie offshore, DP certs etc or Any other not already mentioned
Name of Course / Certificate
APPROVALS
Place
Issue Date
Cert No
Expiry
BOSIET
HUET
FOET
OFFSHORE MEDICALS
( UK, NORWAY or NETHERLAND )
Re-Breather training
Initial Standby vessel crews training ( ITSO )
CAA (Civil Aviation Authorities – Helicopter)
Advanced Medical Aider ( AMA )
HLO
HLA
MARLIN’s English Test
Score: %
IELTS-English TEST
http://www.ielts.org/test_centre_search/search_results.aspx
SCORE
PMS maintenance system – Confirm that you are Familiar with its use ( YES / NO )
DEEP WATER ANCHOR HANDLING EXPERIENCE
ENTER DEPTH IN METERS
DP Maintenance Courses
DP Maintenance Courses
HIGH VOLTAGE COURSE
Dynamic Positioning Induction Course
Dynamic Positioning Simulator Course
Dynamic Positioning Operators CERTIFICATE
Full or Limited
Dynamic Positioning Log book Details
Section 10 Hours done with various DP system
SYSTEM DETAILS
Approx Hours as SDPO / Approx Days in case of Senior ETO / Senior Engineer
Approx Hours as DPO / Approx Days in case of Junior ETO / Junior Engineer
APPROXIMATE Total DP Hours in Various Operations
SAT DIVING
CABLE LAYING
AIR DIVING
SURVEY
ROV
PIPE LAYING
WELL STIMULATION / INTERVENTION / ACTIVATION
DRILL SHIP / SEMI SUB
AHTS
PSV
FPSO
SHUTTLE TANKER
CONSTRUCTION
ROCK DUMPING / MATTRESSING
CORING
TRENCHING
HEAVY LIFT
ACCOMMODATION / GANGWAY
Page 3 of 7
Section 11 Medical History
YES
NO
Have you ever signed off a ship due medical reason ?
x
Have you undergone any medical operations in past ?
x
Have you consulted a doctor during the past 12 months for an illness / Accident
x
Do you have any health or disability problem now ?
x
If answer to any of above is YES then give further details below or on a separate sheet
Section 12 General
Yes
No
Have you ever been involved in a maritime accident, ie grounding, fire, Explosion, Collision, etc
x
Have you ever been the subject of a court of enquiry or involved in a maritime accident
x
Have you ever had a professional licence suspended or revoked
x
Have you ever been convicted of any criminal offence?
x
Have you ever been dismissed
x
If yes to any of above then please full details below or on separate sheet of paper
Section 13 References (Last Two Recent Employers)
Name of company
Briese schihffart
Name Person to be contacted
Timonov Sergey
Address
344002 Rostov-on-Don Baumana str. 64
Tel No
Fax
***********@*****.**
Section 16 Record of Sea Service (All Dates to be entered as dd/mm/yy)
Please give full record of sea service STARTING FROM LAST VESSEL FIRST
VESSEL
COMPANY
Type of Vessel
And Type of operation in case of DP vessels
DWT or GRT
(please delete as reqd)
Type of Engines
Or DP System
BHP
RANK
Sign on DATE
Sign off DATE
dd / mm / yy dd / mm / yy
BBC Hudson
Briese schihffart
Hevy lift
12478
Deck cadet
16.09.2013
05.03.2014
Nikolay Konarev
Aship service
Ro-ro
14795
Able seaman
03.07.2012
12.11.2012
ADDITIONAL INFORMATION SHEET
VESSEL TYPE YOU ARE INTERESTED IN (please list in order of priority)
1.
2.
3.
4.
5.
MAXIMUM ACCEPTABLE CONTRACT PERIOD (Please indicate below)
Please Quote –Consolidated MINIMUM MONTHLY SALARY ( no leave pay ) payable for time onboard only or Working DAY RATE EXPECTATION ( no leave pay) ( please quote below in US$ -preferred or Euro or GBP£ )
Languages Spoken / Written / Understood (1-poor 5-Fluent)
Spoken
Written
Understood
ENGLISH
5
4
4
Contact this candidate