Position applied for :Deck Cadet
Second choice ( if any ) :
Personal data
Name : RUBAILO ANTON
Marital status (single, married, divorced): SINGLE
Date of birth : 10.04.1994
Number of children (under 18 years) : -
Place of birth : SLAVYANSK-ON-KUBAN
Next of kin:
Religion (Christian, Mos., etc.) : Christian
Relationship :
Nationality : RUSSIAN
Address:
Address: SLAVYNSK-ON-KUBAN
Telephone :
Telephone: +791********
Post Code:
Pre-sea education and year of graduation: ADMIRAL USHAKOV MARITIME STATE UNIBERSITY 2017
Diploma No :
Document No
Date of issue
Expiry date
Seaman’s Identification Card
248857
28.11.13
27.11.18
Civil Travel Passport
72 6564630
29.10.13
29.10.23
Medical certificates
Date of issue
Expiry date
Medical Certificate
01.08.16
Colour of eyes : GREEN
Yellow fever
24.01.14
Colour of hair : BROWN
Drug & alcohol test
01.08.16
Height : 88
Cholera
Weight : 189
SEA SERVICE
Period on board
Vessel’s
name
Year built
DWT
Vessel
type
BHP
Type of engine
Flag
Company
Rank
From
To
13.03.14
23.08.14
ENERGY CHANCELLOR
2005
69999
CRUDE/OIL PRODUCT TANKER
18420
B&W
IOM
ENTERPRISES SHIPPING & TRADING S.A.
OS
Remarks: SETS English – EXECELLENT SETS Professional - Visa USA - D.O.A - Last wage -
Name : Position applied for :
STCW Certificates
Document
Grade
Certif. No
Issued on/at
Expiry
Document
Grade
Certif. No
Issued on/at
Expiry
Certif. of Competency
Bridge / Engine Team
Endorsement
Ship’s Handling
GOC / GMDSS
LICOS
GMDSS Endorsement
ECDIS
ARPA
AMOS
Basic Safety
402070
NOVOROSIYSK 26.12.2013
26.12.2018
ISM Code / SMS
Prof. in Survival Craft
54037
NOVOROSIYSK 22.11.2013
22.11.18
Ship’s Security Officer
Adv. Fire Fighting
Ship’s Safety Officer
Med. First Aid / Care
Risk Assessment
Hazardous Materials
Other (please list)
Tankerman General
101310
25.12.13 NOVOROSIYSK
25.13.2018
- // - LPG Specialized
- // - Oil Specialized
- // - Chem Specialized
Other seaman’s books and licenses
Country of Flag State
Grade
Document
No
Date of
Issue
Expiry
Date
Country of Flag State
Grade
Document
No
Date of
Issue
Expiry
Date
Please complete the following for references
Company
Tel.
Company
Tel.
Address
Address
Applicant’s Signature :
Date :