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SEAMAN’S EMPLOYMENT APPLICATION FORM
Position applied for: Chief Mate OOW Available from: 02.2017
Family name: Grigorenko First name: Ivan
Personal particulars
Date of birth: 23/11/1985 Place of birth: Russia Nationality: Russian
Marital status: married Color of hair: brown Color of eyes: grey
Height (cm): 178 Weight (kg): 95 Size: XXL Shoes: 43
Telephones: +7 9289549847
E-mail: ivan.grigorenko@mail.ru Skype: ivangrigorenko
Documents and certificates
Documents No Place of issue Date of issue Valid until
Seaman’s book MK 0189310 Russia, Rostov on Don 30/10/2013 -
Seafarer’s Identity Document RUS 0102214 FSI “Azov – Don
SBDWN”
11/03/2013 10/03/2018
Civil travel passport 71 0232611 Russia, Rostov on Don 06/04/2010 06/04/2020
Certificate of
Competency
Grade No Place of issue Date of issue Endorsement
valid until
Chief Mate CB 095868 Taganrog 28/12/2016 11/11/2021
STCW Certificates No Date of issue Valid until
Basic safety/survival at sea 0611612 06/12/2016 06/12/2021
ECDIS 0523535 11/11/2016 11/11/2021
GMDSS (GOC) 1013744 28/12/2016 28/12/2021
ROPS 0565101 15/11/2016 15/11/2021
ARPA 0523297 17/11/2016 17/11/2021
Advanced fire-fighting 0591037 01/12/2016 01/12/2021
Trainingofseafarers with designated security duties 0612867 22/12/2016 22/12/2021
Proficiency in survival craft 0692764 02/12/2016 02/12/2021
Medical first aid 40820190 30/11/2016 30/11/2021
Radio Active Concentration Indicator Course TID 90517201504 15/10/2015
FLAGS DOCUMENTS
Seafarers ID No s/book/ EXPIRY ENDOR /
EXPIRY
CYPRUS MRU23118500 CY198087/06.11.2022
RE00739312 /
01.01.2017
MARINE EDUCATION RECEIVED TYPE OF DEGREE RECEIVED From Till
Rostov-on-Don Marine college Technician-navigator-bagerman 2003 2006
Admiral Ushakov
Maritime State University
Engineer of organization and
management of transport
2006 2016
HEALTH CERTIFICATE GipokratPlus 19/09/2016 19/09/2016
YELLOW FEVER 04/05/2008 04/05/2018
English level: good
Sea Service
Rank Vessel’s Main engine Ship-owner/Manager From
(mm.yy)
To
(mm.yy)Name Flag Type DWT Type HP
2nd
Officer Vityaz (exname Geopotes 14) Russia TSHD 12000
Stork
W erkspoor
10150
kW
OOO “Oteko-terminal” 08.2016 01.2017
2nd
Officer Vityaz (exname Geopotes 14) Belize TSHD 12000 Stork
W erkspoor
10150
kW
Flinter 08.2015 01.2016
2nd
Officer Akhtubinsk Russia
cutter
dredger
1619 Caterpillar
5632
kW
GidroTrans 07.2014 01.2015
2nd
Officer Gibraltar Cyprus TSHD 7086
Stork
W erkspoor
7800
kW
BALDRAGA DREDGING WORKS
LTD
04.2013 09.2013
2nd
Officer Gibraltar Cyprus TSHD 7086 Stork
W erkspoor
7800
kW
BALDRAGA DREDGING WORKS
LTD
12.2012 02.2013
Dredge
operator
Gibraltar Cyprus TSHD 7086 Stork
W erkspoor
7800
kW
BALDRAGA DREDGING WORKS
LTD
09.2012 11.2012

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Chief Mate Application Form

  • 1. SEAMAN’S EMPLOYMENT APPLICATION FORM Position applied for: Chief Mate OOW Available from: 02.2017 Family name: Grigorenko First name: Ivan Personal particulars Date of birth: 23/11/1985 Place of birth: Russia Nationality: Russian Marital status: married Color of hair: brown Color of eyes: grey Height (cm): 178 Weight (kg): 95 Size: XXL Shoes: 43 Telephones: +7 9289549847 E-mail: ivan.grigorenko@mail.ru Skype: ivangrigorenko Documents and certificates Documents No Place of issue Date of issue Valid until Seaman’s book MK 0189310 Russia, Rostov on Don 30/10/2013 - Seafarer’s Identity Document RUS 0102214 FSI “Azov – Don SBDWN” 11/03/2013 10/03/2018 Civil travel passport 71 0232611 Russia, Rostov on Don 06/04/2010 06/04/2020 Certificate of Competency Grade No Place of issue Date of issue Endorsement valid until Chief Mate CB 095868 Taganrog 28/12/2016 11/11/2021 STCW Certificates No Date of issue Valid until Basic safety/survival at sea 0611612 06/12/2016 06/12/2021 ECDIS 0523535 11/11/2016 11/11/2021 GMDSS (GOC) 1013744 28/12/2016 28/12/2021 ROPS 0565101 15/11/2016 15/11/2021 ARPA 0523297 17/11/2016 17/11/2021 Advanced fire-fighting 0591037 01/12/2016 01/12/2021 Trainingofseafarers with designated security duties 0612867 22/12/2016 22/12/2021 Proficiency in survival craft 0692764 02/12/2016 02/12/2021 Medical first aid 40820190 30/11/2016 30/11/2021 Radio Active Concentration Indicator Course TID 90517201504 15/10/2015 FLAGS DOCUMENTS Seafarers ID No s/book/ EXPIRY ENDOR / EXPIRY CYPRUS MRU23118500 CY198087/06.11.2022 RE00739312 / 01.01.2017 MARINE EDUCATION RECEIVED TYPE OF DEGREE RECEIVED From Till Rostov-on-Don Marine college Technician-navigator-bagerman 2003 2006 Admiral Ushakov Maritime State University Engineer of organization and management of transport 2006 2016 HEALTH CERTIFICATE GipokratPlus 19/09/2016 19/09/2016 YELLOW FEVER 04/05/2008 04/05/2018 English level: good Sea Service Rank Vessel’s Main engine Ship-owner/Manager From (mm.yy) To (mm.yy)Name Flag Type DWT Type HP 2nd Officer Vityaz (exname Geopotes 14) Russia TSHD 12000 Stork W erkspoor 10150 kW OOO “Oteko-terminal” 08.2016 01.2017 2nd Officer Vityaz (exname Geopotes 14) Belize TSHD 12000 Stork W erkspoor 10150 kW Flinter 08.2015 01.2016 2nd Officer Akhtubinsk Russia cutter dredger 1619 Caterpillar 5632 kW GidroTrans 07.2014 01.2015 2nd Officer Gibraltar Cyprus TSHD 7086 Stork W erkspoor 7800 kW BALDRAGA DREDGING WORKS LTD 04.2013 09.2013 2nd Officer Gibraltar Cyprus TSHD 7086 Stork W erkspoor 7800 kW BALDRAGA DREDGING WORKS LTD 12.2012 02.2013 Dredge operator Gibraltar Cyprus TSHD 7086 Stork W erkspoor 7800 kW BALDRAGA DREDGING WORKS LTD 09.2012 11.2012