1. COMPANY WORK FORM Form No. F.6.2
SEAFARERS’ APPLICATION FORM
Issue A Date
Authorised By
01/11/06
MD
DATE AVAILABLE: 15.03.2015
POSITION APPLIED FOR: 2n
d engineer
FULL NAME: Valentins ATTACH
SURNAME:Saveiko PHOTO
FIRST NAME: HERE
MIDDLE NAME(S)
PERSONAL DETAILS
DATE OF BIRTH 24.04.1982 PLACE OF BIRTH NATIONALITY HEIGHT 179
WEIGHT 98 HAIR COLOUR blond EYE
COLOUR
blue
MARITAL STATUS married SPOUSE’S NAME Galina Saveiko No. of
Children
1
FATHER’S NAME Juris Saveiko MOTHER’S NAME Danuta Saveiko NEXT OF
KIN
wife
HOME ADDRESS Latvia, Riga, Vairogu str 29-27
(PERMANENT)
TEL. No. +37122303444
OTHER ADDRESS TEL. No. +37126217120
E-MAIL: valentinsaveiko@gmail.com Mob No.
LICENCES / DOCUMENTS HELD
ITEM No. I S S U E D
DATE PLACE BY
EXPIRING
DATE
GRADE
NATIONAL LICENCE 82/15 06.02.2015 Riga 3000 KW or
more
STCW ENDORSEMENT 82/15-1 06.02.2015 Riga 26.07.2017 Ch.eng
MARSHALLS ISL. ENDORSEMENT 367591 21.05.2015 26.07.2017 Ch.eng
LIBERIAN ENDORSEMENT
OTHER LICENCE
PASSPORT LV40172
12
25.07.2012 Riga 24.07.2022
NATIONAL SEAMAN’S BOOK/CDC 0253545 16.02.2011 Riga 16.02.2021
OTHER SEAMAN’S BOOK / CDC
U.S.VISA 2012213
0390003
03.08.2012 Riga 01.08.2017
YELLOW FEVER VACCINATION 0253545 27.10.2011 Riga
P.R.C. No. (Filipino Crew only)
National data base of seafarers INDOS
Certificate No. (Indian personnel only)
CERTIFICATES HELD
ITEM No. ISSUED EXPIRING ISSUED BY
BASIC SAFETY TRAINING (*IF ONE CERTIFICATE) 80b-098/14 14.07.2014 26.07.2017 novikontas
PERSONAL SAFETY & SOCIAL RESPONSIBILITIES*
PERSONAL SURVIVAL*
SURVIVAL CRAFT HANDLING*
FIRST AID AT SEA (ELEMENTARY LEVEL)*
PROFICIENCY IN SURV.CRAFT/ RESCUE BOAT (PSCRB) 80a-210/13 08.07.2013 08.07.2018 novikontas
ADVANCED / SHORE-BASED FIREFIGHTING 80c-527/13 11.12.2013 11.12.2018 novikontas
PETROLEUM TKR SAFETY – BASIC/ GEN OIL TKR FAM.
MEDICAL FIRST AID 46-062/14 23.01.2014 unlimited novikontas
SHIP MASTERS MEDICARE/ADVANCED MEFA
PETROLEUM TKR SAFETY – ADVANCED/SPECIALISED
COW / IGS
DANGEROUS CARGO ENDORSEMENT - OIL
CHEMICAL TANKER SAFETY
LIQUIFIED GAS FAMILIARISATION 29071/07 20.07.07 unlimited LSC
LIQUIFIED GAS SPECIALISED/ADVANCED COURSE 21-032/09 24.04.2009 unlimited novikontas
DANGEROUS CARGO ENDORSEMENT - LIQUIFIED GAS
LICOS (FOR LIQUIFIED GAS – PLS SPECIFY)
LIQUIFIED GAS-SPECIFIC FIRE FIGHTING – PLS SPECIFY
SIGTTO
STCW ENDORSEMENT
ARPA
R.O.C. / RANSCO / RADAR SIMULATOR
SATCOM
Rev. 2 dated 09/07/12
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2. COMPANY WORK FORM Form No. F.6.2
SEAFARERS’ APPLICATION FORM
Issue A Date
Authorised By
01/11/06
MD
APPLICANTS NAME: _________________________________________________________
CERTIFICATES HELD (CONTINUED)
ITEM No. ISSUED EXPIRING ISSUED BY
GOC / GMDSS
ECDIS
SHIP MANOEUVERING/SHIP HANDLING SIMULATOR
SHIP SECURITY OFFICER 74-953/13 16.07.2013 unlimited novikontas
ISPS FAMILIARISATION
SHIPBOARD SAFETY OFFICER
ENGINE ROOM SIMULATOR 26-006/10 05.02.2010 unlimited novikontas
ENGINE ROOM RESOURCES MANAGEMENT 25-037/14 24.01.2014 unlimited novikontas
HUMAN RELATIONS
QUALITY AND SAFETY MANAGEMENT
RISK ASSESSMENT / RISK MANAGEMENT
MARINE ACCIDENT/INCIDENT INVESTIGATION
MANAGEMENT OF CHANGE
ENVIRONMENTAL COURSE / ISO 14001
MLC/LSC MARITIME LEADERSHIP COURSE
MARPOL I
MARPOL II
MARPOL VI
MARITIME ENGLISH
MLC 2006
BRIDGE TEAM MANAGEMENT
BRIDGE RESOURCES MANAGEMENT
RECORD OF PREVIOUS SERVICE (VERIFIED AGAINST SEAMAN’S BOOK ENTRIES)
COMPANY VESSEL’S
NAME
TYPE/
BUILT
DWT M/ENG’SBHP/
TYPE
UMS
( Y-
N)
RANK FROM TO MONTHS
NAKILAT AL GATTARA LNG 106898 B&W
2x18660KW
Y 2n
d eng 27.04
.2015
04.08
.2015
3
SHELL LIJMILIYA LNG 155159 B&W
2x19270KW
Y 2nd
eng
27.08
.2014
22.12
.2014
3
SHELL AL
GHUWAIRIYA
LNG 154940 B&W
2x19270KW
Y 2nd
eng
28.02
.2014
01.06
.2014
3
SHELL AL MAYEDA LNG 130298
B&W
2x18940KW
Y 2nd
eng
14.08
.2013
23.11
.2013
2.5
SHELL AL MAYEDA LNG 130298 B&W
2x18940KW
Y 2nd
eng
10.02
.2013
26.04
.2013
2.5
SHELL AL MAYEDA LNG 130298 B&W
2x18940KW
Y 2nd
eng
12.08
.2012
14.11
.2012
3
THOME RAGGIANA LPG 23479 B&W 11640
HP
Y 2nd
eng
31.10
.2011
18.04
.2012
6
THOME APODA LPG 23469 B&W 13610
HP
Y 2nd
eng
18.03
.2011
18.07
.2011
4
THOME SIGLOO MOON LPG 10195 B&W
8425HP
Y 3rd
eng
15.03
.2010
04.08
.2010
3.5
LSC NEW
ENGLAND
OIL
TANKER
23354 B&W
10119HP
Y 4th
eng
03.10
.2009
06.01
.2010
3
LSC VIDZEME LPG 23479 B&W 11640
HP
Y 3rd
eng
01.05
.2009
13.07
.2009
2
LSC VIDZEME LPG 23479 B&W 11640
HP
Y 3rd
eng
25.12
.2008
10.03
.2009
3
LSC VIDZEME LPG 23479 B&W 11640
HP
Y 3rd
eng
06.04
.2008
17.08
.2008
4
LSC VIDZEME LPG 23479 B&W 11640
HP
Y 3rd
eng
17.08
.2007
08.12
.2007
4
LSC VIDZEME LPG 23479 B&W 11640
HP
Y 3rd
eng
02.01
.2007
20.04
.2007
4
Rev. 2 dated 09/07/12
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3. COMPANY WORK FORM Form No. F.6.2
SEAFARERS’ APPLICATION FORM
Issue A Date
Authorised By
01/11/06
MD
APPLICANT’S NAME: ___________________________________________________________________
ACTUAL TIME SERVED IN MONTHS
RANK LNG LPG CRUDE OIL
TANKER
OBO / CHEM. /
PRODUCT
TANKER
BULK
CARRIER/
OTHER
MASTER OR CH. ENG.
C/OFF OR 1A/E 14 13
2/OFF OR 2A/E 20.5
3/OFF OR 3A/E 5 3
GAS/CARGO ENGINEER
CADET/JR.ENG
ETO / ELEC (PLS STATE)
PMN / FITTER
OTHER RANK
ALLOTMENT DETAILS
SURNAME
NAME
MIDDLE NAME
DATE OF BIRTH
RELATIONSHIP
ADDRESS
NAME OF BANK
ACCOUNT No.
SSS No. (Filipino crew only)
TIN No. (Filipino crew only)
WIFE &CHILDREN’SNAMES
DOB POB PASSPORT NO. DATE OF
ISSUE EXPIRY
ISSUED AT
How long did you stay at your previous company? 3 years
Wages on last vessel? 70600 USD per year
Trade route of vessels?
Who referred you to the company? colleagues
Any relatives with the company?
If yes, who?
ANY OTHER INFORMATION ABOUT YOURSELF:
UNION MEMBERSHIP NO.: DATE :
DOE:
ALL APPLICANTS
DATE APPLICATION FILLED OUT
SIGNATURE OF APPLICANT
FULL NAME IN BLOCK CAPITALS
Rev. 2 dated 09/07/12
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