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  • Seaman'S Pre-Employment Check List: Lesha - Kuznecov.93@

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    Лёша Кузнецов
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    This document contains a seaman's pre-employment check list for Aleksei Kuznetsov, including his personal details, national and flag certificates, sea service history, other information, and an interview conclusion section. It lists his name, date of birth, address, qualifications, certificates, past positions and employers. The check list documents that he has the required certifications to serve as a 3rd or 4th officer, and finds him suitable for employment based on the interview.

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    cr03rev3

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    This document contains a seaman's pre-employment check list for Aleksei Kuznetsov, including his personal details, national and flag certificates, sea service history, other information, and an interview conclusion section. It lists his name, date of birth, address, qualifications, certificates, past positions and employers. The check list documents that he has the required certifications to serve as a 3rd or 4th officer, and finds him suitable for employment based on the interview.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    12 views3 pages

    Seaman'S Pre-Employment Check List: Lesha - Kuznecov.93@

    Uploaded by

    Лёша Кузнецов
    This document contains a seaman's pre-employment check list for Aleksei Kuznetsov, including his personal details, national and flag certificates, sea service history, other information, and an interview conclusion section. It lists his name, date of birth, address, qualifications, certificates, past positions and employers. The check list documents that he has the required certifications to serve as a 3rd or 4th officer, and finds him suitable for employment based on the interview.

    Copyright:

    © All Rights Reserved
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    of 3

    ISSUED ON 1ST OCT 2011

    SEAMAN’S PRE-EMPLOYMENT CHECK LIST


    Тел/Факс. +7 495 1080512
    A. PERSONAL DETAILS
    +7 8617 306227
    +7 8692 417130
    +30 211 1987710
    +38 044 4557026
    Тел. Моб. +7 9885095078
    E-mail: seamen@stc.com.ua

    Name Kuznetsov Aleksei Andreevich


    Surname First name Father’s name
    Date and place of birth 17.11.1993

    Nationality Russian Family State

    Home Address Kerch, Popova str23a


    (Permanent residence)
    E-mail, tel. /mob lesha.kuznecov.93@mail.ru

    Trade Education KMTK of Kerch/ graduated at 2015

    ( College / university / academy, date of graduation )

    Marital status (married/single/divorced) single


    Wife Full Name
    Beneficialy Full Name
    Beneficiary Full Name relation
    Beneficiary Address and tel.
    Children names/age

    Position applied for 3rd officer/ 4 officer

    B. NATIONAL AND FLAG CERTIFICATES

    Title of the seafarer’s National documents Number Date of issue Place of issue Valid till
    Seaman’s book 0132464 23.12.16 FSBI black sea 22.12.2021
    Civil passport 4714453263 2304.14 Kerch
    Ukrainian domestic passport
    2030305619
    Certificate of competency OOW(NAVIGATIONAL) 22.12.16 ASTRAKHAN 23.08.21
    1013582*203240380 22.12.16 ASTRAKHAN
    Endorsement of Certificate (Limitations ,if any -NIL) 5
    16.11.21
    Flag Endorsement of Certificate (Flag _______________ )
    _______________
    Basic safety training Certificate 0647644 23.08.16 ASTRAKHAN 22.08.21
    Proficiency in Survival craft and rescue Boat Certificate 0596867 25.08.16 ASTRAKHAN 25.08.21
    Advanced fire fighting Certificate 0596232 23.08.16 ASTRAKHAN 26.08.21
    Carriage of dangerous cargo Certificate
    Medical first aid / Medical care Certificate 0596931 31.08.16 ASTRAKHAN 31.08.21
    GMDSS certificate (Capacity ______________________) 1013582*203040380 22.16.16 ASTRAKHAN
    5
    Endorsement of GMDSS (Limitation, if any___________)
    Flag endorsement of GMDSS (Flag__________________)
    Radar navigation Certificate 0274639 16.09.16 ASTRAKHAN 16.09.21
    ARPA Certificate 0275810 23.09.16 ASTRAKHAN 23.09.21
    ECDIS Certificate 0277866 30.09.16 ASTRAKHAN 30.09.21
    Ships Safety Officer Certificate
    Ship Security Officer Certificate 0597846 01.09.16 ASTRAKHAN 01.09.21

    PAGE 1 OF 2
    SEAMAN’S PREEMPLOYMENT CHECKLIST CR03 REVISION: 3
    ISSUED ON 1ST OCT 2011
    Flag endorsement SSO Certificate (Flag ______________)
    Bridge team management Certificate
    Medical certificate 24.11.16 KERCH 24.11.17
    Yellow fever vaccination Certificate 12.08.2012 KERCH 12.08.2022
    Drug and alcohol testy Certificate

    English language knowledge: Marlin’s test (%)


    VERY GOOD!
    (verygood/good/poor)
    Working clothes Shoes size Height Weight Eyes Hair
    size___50___ ___42____ __170____ ___75__ color__blue____ Color:__black____

    C. SEA SERVICE ( last ten contracts)

    Vessel’s name Type Flag DWT M/E Rank Signed Company


    maker power on off
    Piotr Zhitnikov reefer rus 32096 os 29.04.13 13.11.13 DMP

    Altona General malta 4700 AB 28.04.14 18.09.14 Nord Sail Comp


    cago welder
    Delamar MTP gibralt 4300 os 24.01.15 28.07.15 briese
    ar
    Saxum MTP gibralt 3700 os 14.02.16 12.08.16 briese
    ar

    D. OTHER INFORMATION

    Previous Employment (please indicate the companies that he worked the two last contracts)

    Company name Address Phone Rank From To

    Other countries visits (USA, SHENGEN)

    (Specify the country and year of each visit for last 5 tears)

    USA, Australia, Schengen VISA (Specify Country and validity date )

    Are any Liabilities in progress? (Alimony, judicial claims and etc.)

    All above-stated is true. The present I allow to store and use the information received from me with a view of my employment.

    Date and applicant signature_______________

    E. INTERVIEWER CONCLUSION

    When available for Employmenmt 23.01.17


    Reference (from Whom, details)
    PAGE 2 OF 2
    SEAMAN’S PREEMPLOYMENT CHECKLIST CR03 REVISION: 3
    ISSUED ON 1ST OCT 2011

    Ability
    Character
    Qualification
    Motivation
    Remarks

    Found Suitable____________ Hold for possible reconsideration __________ Not suitable _____________

    Interviewer’s Name and signature


    Date and place of Interview

    PAGE 3 OF 2
    SEAMAN’S PREEMPLOYMENT CHECKLIST CR03 REVISION: 3

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