APPLICATION FORM Form C-** *-**/**/**/GM

Name in full

First: Georgije

Middle: Milan

Family name: Kurtinovic

Nationality: MNE

photo

Date & place of birth: 06.02.1999. Kotor,MNE

Marital status: Single

Present address: Herceg Novi,MNE

Name of next of

kin and address

Nearest airport: Tivat Airport

Education history: Maritime Engineering school

Color of hair/eyes

brown/brown

Height

1.87m

Weight 98kg

License

country

Grade of license

Number

Date issued

Place issued

Date expires

Montenegro

Seaman’s book

number

Place & date issued

Date expires

Passport number

Place & date issued

Date expires

0008344

10.08.2018

10.08.2028

H41KH4769

11.09.2018

11.09.2028

US VISA

Availability for Service

Availability for Position

PREVIOUS SEA EXPERIENCE FOR LAST FIVE YEARS OR LAST 10 SHIPS SERVED

Vessel’s name

Flag

Engine: Type & H.P.

Deck: Trade & GRT

Type of Vessel

TEU capacity

Company’s name

Rank

Period of service

from to

Knowledge of English language:

1.excellent

2.very good

3.good

4.moderate

5.poor

Address and tel. no. of present/last employer

CERTIFICATES & COURSES ATTENDED & ENDORSEMENT OBTAINED

Licenses held:

Rank:

License No.:

Place and date of issue:

Date of expiry:

National CoC

National Endorsement

Flag Endorsement

Course:

Place attended:

Certificate No.:

Date of issue:

Date of expiry:

Basic training

Kotor

342/18-05/2-4228/1

17.08.2018.

17.08.2023.

Medical first aid cert

Kotor

342/18-05/2-4230/1

17.08.2018.

17.08.2023.

Procedures in case of security threats

Cert. for seafarers with design. security duties

Kotor

342/18-05/2-4229/1

17.08.2018.

17.08.2023.

Security awareness

Kotor

342/18-05/2-4227/1

17.08.2018.

17.08.2023.

SSO

Ship safety officer

Radar & ARPA

GMDSS

ECDIS generic

ECDIS specific

Type

BRM

BTM

MRM

ERM

Adv. fire fighting

Medical care cert

Prof. in survival craft

Prof. in fast rescue boats

Dangerous cargo handl.

Oil & chemical tanker cargo operations

Adv. oil tanker cargo operations

Adv. chemical tanker cargo operations

Liquefied gas tanker cargo operations

Adv. liquefied gas tanker cargo operations

Ro-Ro passenger cert

Leadership & teamwork

Risk assessment, incident investing. & root cause analysis

Contact this candidate