Капитан-наставник по безопасности мореплавания

Описание

Passport -Country of Issue Russia US Visa - Type
Passport -Date Issued 08/10/2010 US VISA Expires
Passport -Place Issued Rostov Don, Russia Seaman Book no MK 0114917
Passport Number 72 1466499 Seaman Book Issue Date 17/04/2012
Passport -Expires 08/10/2022 Seaman Book Expiry Date (if any) N/A

Section 4 Next of Kin

Full Name / Relationship Gladkova Tatyana / Wife
Address Kraevedchaskiy,10,Rostov-Don,Russia,344011
Contact Numbers +7 909 4281358

Page 1 of 7
Section 5 Highest Certificate of Competency / Licence Held ( also list Flag State Endorsements)

Class / Grade Issuing Country Certificate No. Date Issued Expires Details of Limitations

Master Russia 2020106910 24/01/2011 14/08/2020 None
Master Russia 2020106910 24/01/2011 14/08/2020 None

Section 6 Dangerous Cargo Endorsements

Section 7 Courses Attended and Certificates Obtained

Name of Course / Certificate Institute Place Date Cert No Expires

Basic Sea Survival Nav. Academy Russia 25/08/15 0043917 25/08/20
Proficiency in Survival Craft Nav. Academy Russia 25/08/15 0229183 25/08/20
Personal safety & Social Responsibility
Fire Fighting
Advanced Fire Fighting Nav. Academy Russia 01/09/15 0044917 01/09/20
Medical & First Aid Nav. Academy Russia 03/09/15 0045553 03/09/20
Ship Captains Medical Course
GMDSS + ENDORSEMENT Nav. Academy Russia 05/10/15 1013167 17/09/20
Ship Security Officers Course (SSO) Nav. Academy Russia 23/04/15 036376 23/04/20
(ISPS)
Personal Survival Techniques
Medical Certificate / HEALTH Certificate Medical Centre Russia 16/05/17 n/a 16/05/18
UKOOA
Medical Care Nav. Academy Russia 03/09/15 0045553 03/09/20
Radar Observer Nav. Academy Russia 18/08/15 0152421 18/08/20
Radar Simulator
ARPA Nav. Academy Russia 20/08/15 0152803 20/08/20
Bridge Team Management
Bridge Resources Management
ISM Code
Petroleum Tanker Safety Course
Liquified Gas Tanker Safety Course
Designated Security Duties Nav. Academy Russia 09/09/15 0275568 09/09/20
ECDIS Nav. Academy Russia 14/08/15 0472869 14/08/20
FRC
Dangerous cargo Nav. Academy Russia 28/08/15 0334287 28/08/20
Page 2 of 7
Section 7 (continued) Courses Attended and Certificates Obtained
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 Institute Place Date Cert No Expires

Initial Standby vessel crews training ( ITSO )
H2S
CAA (Civil Aviation Authorities – Helicopter)
Proficiency in RESCUE BOATS
Proficiency in RESCUE CRAFTS
Advanced Medical Aid
Electronic chart Display and Information System
course
YELLOW FEVER Med. Centre Russia 07/12/09 0712/20
BOSIET
MARLIN’s English Test
DP Maintenance Courses
DP Maintenance Courses
Dynamic Positioning Induction Course
Dynamic Positioning Simulator Course
Dynamic Positioning Operators CERTIFICATE
Dynamic Positioning Log book Details

Section 8 Hours done with various DP system

SYSTEM DETAILS Approx Hours as SDPO / Senior ETO / Senior Approx Hours as JDPO / Junior ETO / Junior
Engineer Engineer

APPROXIMATE Total DP Hours in Various Operations
SAT DIVING CABLE LAYING
AIR DIVING SURVEY
ROV PIPE LAYING
WELL STIM / ACTIVATION / INTERVENTION DRILL SHIP / SEMI SUB
AHTS PSV
FPSO SHUTTLE TANKER
ACCO / GANGWAY CONSTRUCTION / HL
MATRESSING / ROCK DUMPING TRENCHING
CORE SAMPLING
Page 3 of 7
Section 9 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

NOTE : All our clients have STRICT Alcohol and Drug Policy, Which means ZERO TOLERENCE for alcohol and drugs

Section 10 General
Yes No
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

If yes to any of above then please full details below or on separate sheet of paper

Section 11 References (Last Two Recent Employers)

Name of company Zamil Offshore Services
Name Person to be contacted Bobby Boreta
Address Rahima, Camp, Saudi Arabia

Tel No +966 050 2120305 Fax
Email bobbyboreta@gmail.com

Name of company Bumi Armada
Name Person to be contacted Capt. T.S. Grover
Address Plot 21,Prince Adelowo Adedeji street,Off Admirality Way,
Lagos, Nigeria
Tel No +234(0)8135159929 Fax
Email tejpal.grover@bumiarmada.com

Section 12 Any other information, you wish to add in support of your application

Section 13 Declaration
I hereby declare that the above particulars are true and I authorize you to contact the referees listed above
And confirm that All my certificates / Licences are Authentic

Section 14 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
SL Condor
ADDITIONAL INFORMATION SHEET

VESSEL TYPE YOU ARE INTERESTED IN (please list in order of priority)
1. AHTS
2. Supply Boat

MAXIMUM ACCEPTABLE TRIP LENGTH (Please indicate below)
4
MINIMUM SALARY or DAY RATE EXPECTATION (please quote below in GBP£ (for British Nationals) or in US$ (for NON-UK personnel)
Amount to enter below to be consolidated of any leave pay ( ie, inclusive of leave pay), Please enter MINIMUM in order we can forward your CV for
all offering above that ( please enter Only realistic figure )
400 - 500 US $ per day
Languages Spoken / Written / Understood (1-poor 5-Fluent)

DRUG & ALCOHOL POLICY
ALL Our Clients have very strict NO DRUG and ALCOHOL POLICY, Which is required to be complied with at all times, which means “””ZERO TOLERENCE
on ALCOHOL & DRUG”””
Your body must NOT have any ALCOHOL or DRUG substances from the time you board your flight or commence your travel to join vessel, and Must remain
so Until you have completed full contract and returned to your home Airport / Town
If during the said period you are found under the influence of DRUG or ALCOHOL then ALL EXPENCES incurred which will include all your travel and
recruiting costs, And your relief’s Travel and recruiting costs, And Any other costs whatsoever incurred due to your NON-COMPLIANCE will be
deducted from your salary, Which will include but not limited to “damage to vessel her equipments and machineries, loss of charter, and any other
costs Directly or indirectly connected with your NON-COMPLIANCE

CONFIRM ACCEPTANCE OF ABOVE POLICY
FOLLOWING DOCUMENTS COPIES MUST BE SENT TO US
Licence or Certificate of competency, Any tanker endorsements, GMDSS showing expiry date in case of Deck Officers, Medical Fitness / Examination
Certificate, Passport Main page, Seaman book or Discharge book Main pages, In case of DPO – DPO Cert, DP LOG Pages
FOLLOWING ADDITIONAL DOCUMENTS COPIES MAY ALSO BE REQUIRED
All short courses certificates ( STCW95 ), SSO certificate, Last 3-5 years ships entries in Discharge book or Seaman book, Certificate of
Equivelant Competency from other flag states