APPLICATION FOR EMPLOYMENT

Application Date: 15/04/2021

APPLICATION FOR POSITION AS 2ND OFFICER JDPO OTHER POSITION (IF ANY) 3RD OFFICER JDPO

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 APPLICATION FOR EMPLOYMENT
Application Date: 15/04/2021

1. PERSONAL DETAILS
TITLE MR/MRS/MISS MR SEX MALE X FEMALE
SURNAME HEYDAROV
FIRST NAME HEYDAR OTHERS NAMES N/A
DATE OF BIRTH 14.01.1996 PLACE OF BIRTH AZERBAIJAN
NATIONALITY AZERBAIJANIAN MARITAL STATUS SINGLE
COLOUR OF EYES BROWN COLOUR OF HAIR BLACK
MOTHER’S NAME DJAMILA FATHER’S NAME ALISHAN
MOTHER’S MAIDEN NAME ABDULLAYEVA
HEIGHT (CM) 171 WEIGHT (KG) 75
NEAREST INTERNATIONAL AIRPORT: H.ALIYEV INTERNATIONAL AIRPORT
2. ADDRESS ADDRESS (TEMP.) FROM/TO:
NO & STREET KHATAI DISTRICT, ZIGH HIGHWAY, NO & STREET N/A
PIVZAVOD STREET, HOME 28/3
CITY BAKU CITY N/A
POST CODE AZ1018 POST CODE N/A
COUNTRY AZERBAIJAN COUNTRY N/A
TEL. NO. +994555349478 TEL. NO. N/A
MOBILE +994515349478 MOBILE N/A
E-MAIL heyder_96@mail.ru E-MAIL N/A
FAX N/A FAX N/A
3. NEXT OF KIN
FULL NAME HEYDAROV ALISHAN RELATIONSHIP FATHER
ADDRESS KHATAI DISTRICT, ZIGH HIGHWAY, PIVZAVOD STREET, HOME 28/3
CITY BAKU COUNTRY AZERBAIJAN
TEL. NO. +994123726874 MOBILE +994507379873 FAX NO. N/A
4. TRAVEL DOCUMENTS
TYPE DOCUMENT NO. ISS.DATE EXP. DATE ISS. BY (AUTHORITY) PLACE OF ISSUE
PASSPORT C02153502 14.08.2018 13.08.2028 MINISTRY OF AZERBAIJAN
INTERNAL AFFAIRS
SEAMAN BOOK DQK 014762 02.08.2019 02.08.2024 AZERBAIJAN STATE AZERBAIJAN
MARITIME
ADMINISTRATION
5. BANK ACCOUNT INFORMATION
BANK NAME BANK RESPUBLIKA OJSC BRANCH AZNEFT
BANK ADDRESS NEFTCHILER AVENUE 67
CITY BAKU COUNTRY AZERBAIJAN
SORT CODE N/A ACCOUNT NO AZ23BRES41020US0021084714001
BANK SWIFT CODE BRESAZ22 BANK TEL. NO +99412144
ACCOUNT OWNER’S NAME HEYDƏROV HEYDƏR
ACCOUNT OWNER’S ADDRESS KHATAI DISTRICT, ZIGH HIGHWAY, PIVZAVOD STREET, HOME 28/3

6. EDUCATION
SCHOOL NAME AZERBAIJAN STATE MARINE ACADEMY FROM 2013 TO 2017

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 APPLICATION FOR EMPLOYMENT
Application Date: 15/04/2021

7. PROFESSIONAL QUALIFICATION / CERTIFICATE OF COMPETENCY

ISSUE EXPIRY ISSUED BY
CERTIFICATE NAME NUMBER ISSUED AT
DATE DATE (AUTHORITY)
AZERBAIJAN
OFFICER IN CHARGE OF A
0007025 31.07.2019 31.07.2024 STATE MARITIME AZERBAIJAN
NAVIGATIONAL WATCH
ADMINISTRATION
AZERBAIJAN
ENDORSEMENT OF COC 000555/19 31.07.2019 31.07.2024 STATE MARITIME AZERBAIJAN
ADMINISTRATION
ASCO TRAINING
DP INDUCTION DPI160/21 26.02.2021 26.02.2026 CENTER AZERBAIJAN
(NI APPROVED)
NAUTICAL
DP LOGBOOK 19OF0000853 26.02.2021 N/A AZERBAIJAN
INSTITUE
8. LANGUAGES
ENGLISH FLUENT GOOD X FAIR POOR

TURKISH FLUENT X GOOD FAIR POOR

RUSSIAN FLUENT GOOD X FAIR POOR

MARLIN’S TEST / LEVEL ISSUED DATE RESULT % ISSUED BY (AUTHORITY) ISSUED AT

UPPER INTERMEDIATE 06.04.2021 93 United Alliance Group AZERBAIJAN
9. HEALTH CERTIFICATES & VACCINATIONS
ISSUE EXPIRY ISSUED BY
FLAGE STATE NUMBER ISSUED AT
DATE DATE (AUTHORITY)
UNIKLINIKA
INTERNATIONAL(OGUK)
N/A 11.09.2020 11.09.2021 MEDICAL AZERBAIJAN
OFFSHORE MEDICAL
CENTER (OGUK)
NAME ISSUE DATE EXPIRY DATE ISSUED BY (AUTHORITY) ISSUED AT
MediClub Clinic
YELLOW FEVER 07.04.2021 07.04.2031 Azerbaijan
(WHO APPROVED)
10. SAFETY CLOTHING
BOILERSUIT SIZE S BOOTS SIZE 41
11. MARINE COURSES
ISSUE EXPIRY ISSUED BY
COURSE NAME NUMBER ISSUED AT
DATE DATE (AUTHORITY)
AZERBAIJAN
BASIC SAFETY TRAINING SO-0589-20 22.04.2020 13.03.2025 STATE MARITIME AZERBAIJAN
ADMINISTRATION
AZERBAIJAN
ADV. FIRE FIGHTING SJ-0222-20 12.05.2020 19.03.2025 STATE MARITIME AZERBAIJAN
ADMINISTRATION
04.12.2 AZERBAIJAN
SHIP HANDLING AND 019
MANEOUVRING SV-0300-19 04.12.2024 STATE MARITIME AZERBAIJAN
ADMINISTRATION

AZERBAIJAN
BRIDGE RESOURCE
MANAGEMENT SW-0182-19 28.06.2019 28.06.2024 STATE MARITIME AZERBAIJAN
ADMINISTRATION
AZERBAIJAN
MEDICAL FIRST AID SN-0387-19 04.06.2019 03.06.2024 STATE MARITIME AZERBAIJAN
ADMINISTRATION
AZERBAIJAN
LEADERSHIP AND TEAMWORK DL-0177-19 12.06.2019 12.06.2024 STATE MARITIME AZERBAIJAN
ADMINISTRATION

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 APPLICATION FOR EMPLOYMENT
Application Date: 15/04/2021

AZERBAIJAN
DESIGNATED SECURITY
DUTIES SH-0773-19 14.05.2019 14.05.2024 STATE MARITIME AZERBAIJAN
ADMINISTRATION
AZERBAIJAN
PROF. IN SURVIVAL CRAFT &
RESCUE BOATS SL-0285-21 05.03.2021 05.03.2026 STATE MARITIME AZERBAIJAN
ADMINISTRATION
FAST RESCUE CRAFT AZERBAIJAN
SU-0240-19 27.11.2019 27.11.2024 STATE MARITIME AZERBAIJAN
ADMINISTRATION
AZERBAIJAN
G.M.D.S.S.(OPERATIONAL
LEVEL) DQ-0214-17 07.06.2017 07.06.2022 STATE MARITIME AZERBAIJAN
ADMINISTRATION
AZERBAIJAN
RADAR ARPA (OPERATIONAL
LEVEL) SR-0056-17 09.06.2017 09.06.2022 STATE MARITIME AZERBAIJAN
ADMINISTRATION
AZERBAIJAN
ISM CODE SP-0025-21 15.01.2021 14.01.2026 STATE MARITIME AZERBAIJAN
ADMINISTRATION
AZERBAIJAN
ISPS BASIC FAMILIARIZATION SI-0736-17 29.04.2017 29.04.2022 STATE MARITIME AZERBAIJAN
ADMINISTRATION
AZERBAIJAN
ECDIS SZ-0174-17 08.06.2017 08.06.2022 STATE MARITIME AZERBAIJAN
ADMINISTRATION
AZERBAIJAN
SHIP SECURITY OFFICER SG-0259-20 03.12.2020 03.12.2025 STATE MARITIME AZERBAIJAN
ADMINISTRATION
AZERBAIJAN
BASIC BANKSMAN AND
SLINGER BBS849 31.01.2020 31.01.2023 STATE MARITIME AZERBAIJAN
ADMINISTRATION

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 APPLICATION FOR EMPLOYMENT
Application Date: 15/04/2021

COMPLETE SEA – SERVICE DETAILS

( LAST VESSELS FIRST )
AVAILABILITY
NAME: RANK:
DATE:
PERIOD
ENGINE TYPE
SIGNED SIGNED IN TYPE OF
COMPANY NAME RANK VESSEL NAME MONTHS D.W.T. ( ENGINEERS BHP KW
ON OFF VESSEL
ONLY)
(eg 4.2)
AB/DECK GENERAL SKL
3197 700 515
CUNDA SHIPPING LTD CADET SUADIYE 22.08.2018 14.04.2019 8 CARGO
CASPIAN MARINE NIIGATA
1831 3000 2206
SERVICES B.V 2ND OFFICER TURKAN 15.08.2019 15.09.2019 1 AHTS
CASPIAN MARINE NIIGATA
1831
SERVICES B.V 2ND OFFICER TURKAN 15.10.2019 15.01.2020 3 AHTS 3000 2206
CASPIAN MARINE NIIGATA
1831 3000
SERVICES B.V 2ND OFFICER TURKAN 15.02.2020 15.05.2020 3 AHTS 2206
CASPIAN MARINE NIIGATA
1831 3000
SERVICES B.V 2ND OFFICER TURKAN 15.06.2020 15.09.2020 3 AHTS 2206
CASPIAN MARINE NIIGATA
3 1831 3000
SERVICES B.V 2ND OFFICER TURKAN 15.10.2020 15.01.2021 AHTS 2206
CASPIAN MARINE NIIGATA
2 AHTS 1831 3000
SERVICES B.V 2ND OFFICER TURKAN 15.02.2021 Still working 2206

I declare that the information I have given is, to the best of my knowledge, true and complete. I also declare that the documents submitted are genuine, given and sign by
persons whose names appear on them.
H.HEYDAROV
DATE SIGNATURE

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 APPLICATION FOR EMPLOYMENT
Application Date: 15/04/2021

Ref .No  
Officer Application Form
(For Official Use)  
Medical History
Have you ever signed off from a ship due to medical reasons?
NO 
(If yes give details) *yes/no
 
Date of occurrence
Name of Vessel (dd-mmm-yyyy)
   

   
Brief Description Of illness/Injury/Accident  

Details
Have you ever suffered from any ailment or disease in the past that is likely to render you    
unfit for sea service or likely to endanger the health /well being of others onboard?
NO
(If Yes give details) *Yes/No  
  Details
Do you have any bodily defects or deficiencies?    
NO

(If Yes give details) *Yes/No  

  Details
Are you currently suffering from any ailment or disease that is likely to render you unfit for    
sea service or likely to endanger the healthy /well being of others onboard? NO

(If Yes give details) *Yes/No  

  Details
Are you addicted to alcohol or drug of any kind?    
NO
(If Yes give details) *Yes/No  
  Details
Are you suffering from an ailment that requires you to be on a long -term    
treatment/medication? NO
(If Yes give details) *Yes/No  
  Details
Have you ever deported or banned from entering any country?    
NO
(If Yes give details) *Yes/No  
  Details
Have you ever been convicted of a criminal or drug offence or have any pending offences?  
NO
(If Yes give details) *Yes/No  
  Details
Do you have any obligations towards your current/previous employers?  
NO

(If Yes give details) *Yes/No  

 
I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge and
belief; further, that no certificate of competency or License issued to me has ever been Revoked or Suspended. I also
certify that my medical history contained above is true and any false statement or undisclosed Material information about
past illness or injury will disqualify me from any employment benefits and claims.
 
…………………………………….. ……………………………………..
dd-mmm-yyyy (Format) Signature

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