Downloaded 13 times
crewjob
- 1. COMPANY WORK FORMForm 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 1 of 3
- 2. COMPANY WORK FORMForm 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 2 of 3
- 3. COMPANY WORK FORMForm 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 3 of 3