Вахтенный помощник капитана бункеровочного судна

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APPLICATION FORM APPLICATION FORM RANK APPLIED 3OFF OTHER POSITION (IF ANY) 1. PERSONAL DETAILS SURNAME Desyuk SEX MALE FIRST NAME Ilia MIDDLE NAME Georgievich DATE OF BIRTH 13.09.1998 PLACE OF BIRTH Krasnodar region,Yesk NATIONALITY RUSSIAN MARITAL STATUS SINGLE COLOUR OF EYES COLOUR OF HAIR MOTHER'S NAME SVETLANA FATHER'S NAME GEORGY SHOESIZE BOILER SUIT SIZE (US) HEIGHT (CM) WEIGHT (KG) NEAREST INTERNATIONAL AIRPORT: ENGLISH LEVEL 2. ADDRESS COUNTRY Russia CITY Yesk STREET Zapadnaya 1 POST CODE MOBILE +7-900-238-22-47 EMAIL Idesyuk12@mail.ru SKYPE ID 3. NEXT OF KIN FULL NAME RELATIONSHIP CITY ADDRESS TELEPHONE COUNTRY 4. CHILDREN FULL NAME OF CHILD DATE OF BIRTH SEX M F M F 5. TRAVEL DOCUMENTS TYPE DOCUMENT NO. ISS.DATE EXP. DATE ISS. BY (AUTHORITY) PLACE OF ISSUE PASSPORT 77 5523102 05.02.2025 05.02.2035 Mvd 23004 SEAMAN BOOK SB 0275375 10/12/2020 Admiral Ushakov Maritime State University SID/ULM RUS 0593904 21/07/2022 20/07/2027 FSBI US C1/D VISA OTHER VISAS 6. EDUCATION INSTITUTE NAME Admiral Ushakov Maritime State University FROM 31/08/2018 TO 31/08/2023 INSTITUTE NAME FROM TO 7. LICENSE/CERTIFICATE OF COMPETENCY / CERTIFICATE NAME NUMBER ISSUE DATE EXPIRY DATE ISSUED BY (AUTHORITY) ISSUED AT CERTIFICATE OF COMPETENCY NVS208608722 11/12/2024 30/03/2027 FSBI ENDORSEMENT OIL NVS208589602 02.12.2024 01.12.2028 FSBI ENDORSEMENT CHEM GMDSS NVS208121502 06/03/2024 30/03/2027 FSBI 8. MEDICAL CERTIFICATES & VACCINATIONS MEDICAL CERTIFICATES NUMBER ISSUE DATE EXPIRY DATE ISSUED BY (AUTHORITY) ISSUED AT INTERNATIONAL/ILO 30/11/2025 30/11/2026 PROFIMED D&A 30/11/2025 PROFIMED YELLOW FEVER 31/03/2025 PROFIMED 9. COURSES COURSE NAME NUMBER ISSUE DATE EXPIRY DATE ISSUED BY (AUTHORITY) ISSUED AT PERSONAL SURVIVAL/PST BASIC SAFETY STCW 95 3002030855 21/11/2024 21/11/2029 Institute of Professional Development of Admiral Ushakov Maritime State University FIRE PREVENTION AND FIRE FIGHTING ADV. FIRE FIGHTING 5032215127 27/05/2023 27/05/2028 Institute of Professional Development of Admiral Ushakov Maritime State University ELEMENTARY FIRST AID MEDICAL FIRST AID 1142253938 19/11/2024 19/11/2029 Institute of Professional Development of Admiral Ushakov Maritime State University MEDICAL CARE PERS. SAFETY & SOC. RESP. PROF. IN SURVIVAL CRAFT & RESCUE BOATS 5032215271 19/05/2023 19/05/2028 Institute of Professional Development of Admiral Ushakov Maritime State University FAST RESCUE CRAFT PREVIOUSE DOCUMENTRY EVALUATION SECURITY TRAINING FOR SEAFARERS WITH DESIGNATED SECURITY DUTIES 1142254554 21/11/2024 21/11/2029 Institute of Professional Development of Admiral Ushakov Maritime State University SHIP SECURITY OFFICER G.M.D.S.S. 3022059841 30/03/2022 30/03/2027 Institute of Professional Development of Admiral Ushakov Maritime State University GENERIC ECDIS COURSE 5032217991 26/05/2023 26/05/2028 Institute of Professional Development of Admiral Ushakov Maritime State University TYPE SPECIFIC ECDIS COURSE ROC & ARPA 6022218561 06/06/2022 06/06/2027 Institute of Professional Development of Admiral Ushakov Maritime State University RADAR OBSERVATION 6022218562 06/06/2022 06/06/2027 Institute of Professional Development of Admiral Ushakov Maritime State University HAZMAT BASIC OIL TANKER 2132226358 01/12/2023 01/12/2028 Institute of Professional Development of Admiral Ushakov Maritime State University ADVANCE OIL TANKER 2052260374 07/02/2025 07/02/2030 Institute of Professional Development of Admiral Ushakov Maritime State University BASIC CHEMICAL TANKER ADVANCE CHEMICAL TANKER 2052261524 19/02/2025 19/02/2030 Institute of Professional Development of Admiral Ushakov Maritime State University BASIC GAS TANKER ADVANCE GAS TANKER BRIDGE TEAM MANAGEMENT Guidance on value added training MATRIX (Company specific courses) SHIP MANOEUVRING SIMULATOR ENGINE ROOM SIMULATOR CARGO HANDLING SIMULATOR COURSE RISK ASSESSMENT ISM AWARENESS BRIDGE AND ENGINE ROOM RESOURCE MANAGEMENT ACCIDENT /INCIDENT INVESTIGATION[1] SAFETY OFFICER MARPOL VAPOUR EMISSION ENERGY EFFICIENCY FRAMO[3] VETTING[4] MARITIME ENGLISH SERVICE DETAILS (LAST VESSELS FIRST ) NAME: RANK: AVALIABILITY DATE: COMPANY NAME RANK VESSEL NAME SIGNED ON DATE SIGNED OFF DATE PERIOD IN MONTHS TYPE OF VESSEL D.W.T. ENGINE TYPE ( ENGINEERS ONLY) BHP/KW REASON FOR SIGN OFF Rosmorport cadet Azovskaya 23/03/2021 25/09/2021 6 dredger 915 Rosmorport cadet Kolguev 08/08/2022 10/02/2023 6 tug 256 SIA FMTS OS Caminero 03/04/2024 06/11/2025 7 Oil/chemical tanker 7114 JSC Ilia Muromets 3OFF Valentin Serov 01/07/2025 05/11/2025 4 Oil tanker 4383 JSC Ilia Muromets 3OFF Viktor Vasnetsov 21/12/2025 13/02/2026 1,5 Chemical tanker 6098 REFERENCE CHECK CONTACT DETAILS COMPANY NAME ADDRESS PHONE NUMBER E-MAIL CONTACT PERSON I declare that the information I have given is, to the best of my knowledge, true and complete. I also declare that the documents submitted are genuine and have been signed by the person whose name appears on them. DATE SIGNATURE