Капитан

Описание

Nationality RUSSIAN Religion
Marital Status MARRIED No. of Children 1
Height (cm) 176 Weight (kg) 96
Nearest Airport KRASNOYARSK Color - eyes/hair Eyes: GREY Hair: BROUN
ADDRESS (include telephone country & area codes, advise also secondary or contact addresses if any)
Street & Nr. CHERNYSHEVSKOGO 71
City KRASNOYARSK Skype yudinmaster
State, Country RUSSIA Fax
Postal (ZIP) Code Size: cap/overals/boots C: 58 O: 52 B: 42
NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary)
Family Name YUDINA First Name(s) OLGA
Nationality RUSSIAN
Postal (ZIP) Code SAME P.O. Box (if any)
REMARKS
Requested Rank MASTER Availability Date 01.01.2017
Prefer. Vessel Type GC/MPP Minimum Salary 3000
English Language Skills Spoken: fluent / good / average / poor - Written: fluent / good / average / poor
Other Foreign Languages no
Professional School / Academy - NameFEHEMS 1995
& Period (From - To)

Foreign Crew Experience Phil, polish ,khroatia, romanian
(specify nationalities)
Other Skills
Further Remarks
Please advise how you heard about Newspaper / Advert / Google / Internet / Relative / Other Seafarer
Marlow Navigation: School / University / Other sources
(underline appropriate option)
I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge.
Date Signature:
Note: This form can be returned per email without signature - please ensure however to send a signed printout for our records
afterwards per mail (e.g. with the passport photos and photo copies required). Please sign all 3 pages of the application form
separately.

Attn.: Marlow Navigation - Crew Dept. (AG) - Fax: +357-25882599 - Email: recruitment@marlow.com.cy

SEAFARER'S APPLICATION FORM - Page 2 of 3 - LIST OF DOCUMENTS

Please note that due to legal requirements boarding is only possible after we are in possession of photo copies of all listed
documents and certificates - in urgent cases you may therefore have to send them email (color scans in .jpg format - max. 600 pixel wide and max. 900 pixel high) or by fax or courier. Passport photos may arrive later (by mail).

Family YUDIN First SERGEY Rank MASTER
Name Name(s)
A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES
Document Name (Desciption) Document Number Country Issue Place Issue Date Exp. Date
Passport (загранпаспорт) 715 989 436 RUSSIA 01.09.11 01.09.21
Seaman's Book (паспорт моряка) MK 0056211 RUSSIA 04.12.12 03.12.17
УЛМ/SID RUS 0036525 04.12.12 03.12.17
Seaman's Book (flag state)
Seaman's Book (flag state)
Visa - United States (type C1/D)
Visa - Others (Work/Resid. Permits)
Medical Examination Report 08.11.2016 24.10.2017
Drug & Alcohol Test
Vaccination against Yellow Fever Antwerpen 18.07.08 17.07.18
Vaccination against Cholera
Passport Photos please mail 6 for deck officers & 4 for other ranks (required for flag states)
B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES
- deck & engine certificates & endor- - radio certificates & endorsements - nav., deck, technical & management
sements (officers / ratings) - safety training (surv., fire, medical) courses (radar/ARPA, ISM, Marpol,
- electrical & reefer certificates - tanker courses (oil, chem., gas) simulators, computer, welding etc.)
- cook & steward certificates - passenger vsl, roro, hazmat courses - any flag state certificates
Document Name (Desciption) Document Number Country Issue Place Issue Date Exp. Date
Cert of Competency master no limits 3060103110 Russia Kholmsk 11.11.16 11.11.21
GMDSS GOC 1009203 Russia Kholmsk 11.11.16 11.11.21
Endorsement of GMDSS 1009203 Russia Kholmsk 11.11.16 02.09.21
Basic Training (Solas) 0616620 Russia Novosibirsk 05.09.16 05.09.21
P. in Survival Craft & Rescue boats 0617580 Russia Novosibirsk 06.09.16 06.09.21
Fire Fighting 0617076 Russia Novosibirsk 07.09.16 07.09.21
First aid & medical care 0075350 Russia Novosibirsk 10.09.16 10.09.21
Designated security duties 0619920 Russia Novosibirsk 13.09.16 13.09.21
ARPA 0620604 Russia Novosibirsk 06.10.16 06.10.21
Radar observation and plotting 0620399 Russia Novosibirsk 04.10.16 04.10,21
ECDIS 0620804 Russia Novosibirsk 13.10.16 13.10.21
BT & RM 0077794 Russia Novosibirsk 20.01.17 20.01.22
TБ 542401147012 Russia Novosibirsk 25.01.17