ООО «КОМА Шиппинг Сервис», Конт.тел.8-8152-45-44-69, email: kssl@com.mels.

ru
APPLICATION FOR EMPLOYMENT
Position applied for: Address:
When ready ?
Surname: Home tel:
First name: Mobil tel:
Father’s Name: Email: photo
Date of Birth: Nearest airport: pls insert photo here
Place of Birth: Marital status:
Citizenship: No. of Children
Education: English test

Height: (good,average,poor):
Weight: Shoes:

Passport
Series and № of document Data of Issue Expiry Data Place of issue
Civil (National)
Passport
Travel International
Passport
Seaman’s book

Seaman’s identity
document

Certificate of
Series and № of document Data of Issue Expiry Data Place of issue
Competence
National
Сertificate:
G.M.D.S.S. License

Endorsement of
G.M.D.S.S.

Series and № of document Data of Issue Expiry Data Place of issue

Certificate
Basic Safety
Training :
Survival Craft &
Rescue Boats

Advanced Fire-
Fighting
Medical First
Aid.
Medical Care
Cert. (if any)
Carriage of
dangerous cargo
Radar Observer

ARPA
Ship Security Officer(if any)

Security-awareness training

Medical Certificate
for Service at SEa
Drug/Alcohol test
report
Vaccination Yellow
Fever

Service at sea for the last 5 years

Name of vessel, Type & power of

Type of vessel, deadweight Signed on - signed off dates Rank Owners
owners of vessel main egine

C автоматизированной обработкой моих персональных данных , указанных в анкете, их передачей и хранением в целях трудоустройства согласен: подпись
Date of filling in of this form: