CV - APPLICATION FORM

CV
Personal Data
First Name Last Name / Surname Father’s Name
GURAM MAKHARADZE KEMAL
Nationality Date Of Birth (dd/mm/yy) Place of Birth
GEORGIAN 06/05/1994 SHUAKHEVI, GEORGIA

Position Applied For Available date

Female Male
JUNIOR DECK OFFICER 1ST of JUNE, 2022

Home Address Personal Documents Issued on Valid until

Passport (Country / Number)
25/10/2016 25/10/2026
33, KATAMADZE JEMAL GEORGIA / 15BB27046
STREET, BATUMI, GEORGIA Seaman’s book
15/05/2018 15/05/2023
GE012723
Marital Status:
USA C1/D visa
Single 17/08/2020 10/08/2030
YES / P6292940
Telephone / Mobile / What’s Up
Yellow Fever Vaccination
+995 597 740 521 05/12/2018 Unlimited
+995 597 740 528
E-Mail: Seafarer Medical Fitness
guramm55@gmail.com Certificate 15/04/2021 15/04/2023
054776
Nearest airport: Batumi
English level: Very Good Minimum salary $: Seafarer’s Number:
International Airport
Russian level: Very Good Negotiable 18-01-011335
(BUS)

National Certificates of Competence Tanker Endorsements

country______GEORGIA________________ Management level Operation level
Grade Issued Expires Oil Chemical Gas
OOW / II/1 24/05/2022 24/05/2027 YES YES NIL
GMDSS Operator 30/03/2022 06/01/2027 B 010035 B 010035 N/A
Valid Flag State
Liberia , ISLE OF MAN (UK)
Endorsements
GMDSS GENERAL Valid until:
Native Language: Georgian
General /Restricted 22G09-23-003469 30/04/2024

Other valid certificates and training attended

Basic Safety Training Advanced Fighting Medical First Aid Medical Care ECDIS (Generic)
Ship Security Officer Bridge Team Management Ship Handling Liquid Cargo Handling
ER Management ECDIS (Type Specific) Other (See below list)

Education History: Name of Institution / Level / Obtained Graduation Degree / Graduate Year:

BATUMI STATE MARITIME ACADEMY (BSMA) / BACHELOR / Nautical Sciences - Marine Navigation / 2018

COVID-19 Vaccination
Maker of Dose S/N Cert. No. Date of Issue Remarks
JOHNSON 1808982 N/A 26/08/2021 US Bio-Chem.

Next of Kin
Relation: Mother Tel. Number: +995 597 740528
Address: 33, KATAMADZE JEMAL STREET, BATUMI,
Name, Surname: LIA DAVITADZE
GEORGIA, 6200

Page 1 of 3 CV – Application Form

 CV - APPLICATION FORM
Country of
Title of Certificate No. Date of Issue Valid up STCW Tab.
Issue
Basic Safety Training,
Personal Safety, FFE and BST01-089066 08/05/2018 GEORGIA 03/04/2023 VI/1
Elementary First Aid
Proficiency In Survival
FRB02-107641 15/04/2019 GEORGIA 11/04/2024 VI/2
Craft and Rescue Boat
Training For Seafarers
designated Security SEC01-089065 08/05/2018 GEORGIA 24/03/2023 VI/6
duties
Security-Awareness
SEC01-089065 08/05/2018 GEORGIA 24/03/2023 VI/6
Training
Bridge Resource
BTM04-158409 29/03/2022 GEORGIA 24/02/2027 II/1, I/12
Management
Leadership and
LDT04-158395 29/03/2022 GEORGIA 27/01/2027 II/1, III/6
Teamwork
Medical First Aid MFC04-158397 29/03/2022 GEORGIA 06/02/2027 VI/4
Advanced Firefighting AFT04-158408 29/03/2022 GEORGIA 06/03/2027 VI/3
Use of ECDIS ECS04-158393 29/03/2022 GEORGIA 22/12/2026 I/12
Radar Navigation, Radar
RNA04-158391 29/03/2022 GEORGIA 20/02/2027 II/1, II/2, I/12
Plotting, Use of ARPA
Rating Forming Part of
Navigational Watch / MTA-00-009752 11/03/2019 GEORGIA 07/03/2024 II/4
Support / Navigation
Cargo Handling on ships
carrying dangerous and
CDH02-107642 15/04/2019 GEORGIA 05/04/2024 N/A
hazardous subst. in solid
and packaged form
Advanced Training For
Oil and Chemical Tanker OCG04-158402 29/03/2022 GEORGIA 24/01/2027 V/1-1
Cargo Operations
Basic Training For Oil
OCG01-089064 08/05/2018 GEORGIA 21/03/2023 V/1-1
and Chemical Tanker
Use of Crude Oil
IGC01-089067 08/05/2018 GEORGIA 10/03/2023 N/A
Washing System
Use of Inert Gas System IGC01-089067 08/05/2018 GEORGIA 10/03/2023 N/A

Biometrics
Height: 168 cm Boiler Suit size: S Eyes colour: Brown
Weight: 64 kg. Safety Shoe size: 42 Any Physical Limitations: NIL

Please answer the following questions:

 Did you suffer, or presently suffer from, any disease likely to render you unfit for services at
sea or likely to endanger the health of other persons on board?
YES NO
If yes, please provide details _______________________________________________

 Did you suffer any accident, which rendered you temporary and/or partially disabled? YES NO
 Did you ever undergo psychiatric treatment YES NO
 Are you addicted to alcohol or drugs of any kind? YES NO

I hereby declare that the above facts and information are true and accurate. I further consent to the holding and processing by (i) the owners of any vessel on which I may
be assigned from time to time and (ii) the Managers and any direct or indirect parent or subsidiary or associated or affiliated company of the Managers (together referred to
as "the Companies") for the purposes of my employment, of personal data about me contained herein, or provided to any of the Companies at a later date, including with
respect to personal and pensions administration, employee management and as required to comply with any laws, regulations or contracts applicable to any of the
Companies or their businesses. I understand that this data will be stored in the Managers’ database for the purposes of my current or future employment arranged by the
Managers. Further, I confirm that the above may involve the transfer of my personal data within the Managers’ organization .

Place___________________________ Date ___________________________ Signature ______________________________

Page 2 of 3 CV – Application Form

 CV – APPLICATION FOR EMPLOYMENT

Sea Experience: (List the most recent experience first; use additional sheets as required)
Date From Date To Reason for
Company Flag Vessel Name Type (1) GRT DWT IMO Rank
(dd/mm/yy) (dd/mm/yy) S/off(3)
OIL /
COLUMBIA Marshall Ordinary
CAPE TEMPEST CHEMICAL 42010 73720 9407263 02/05/2021 14/10/2021 EOC
SHIPMANAGMENT Islands Seaman
TANKER

OIL /
ZODIAC MARITIME Ordinary
Liberia HOUYOSHI PARK CHEMICAL 12145 19998 9725847 07/09/2020 29/01/2021 EOC
LTD Seaman
TANKER

GENERAL
ALBROS SHIPPING Malta AZOV CONCORD 6483 8975 9387748 Deck Cadet 12/08/2019 02/03/2020 EOC
CARGO

BESIKTAS SHIPPING Malta BESIKTAS M BULK CARRIER 29353 53020 9291365 Deck Cadet 21/03/2018 23/07/2019 EOC

ISU,
DRY CARGO
HDROENGINEERING Georgia EVA 508 785 7946875 Deck Cadet 01/09/2016 01/03/2017 EOC
CARRIER
COMPANY, BSMA

*Please use only following abbreviations for the vessel type: (1)
Use only the following abbreviations for vsl types:
(2)
GCD General Cargo MLP Multi-Purpose B/C Bulk Carrier CON Container O/O Ore Oil OBO Ore/Bulk/Oil Engineers to give make/model of engines, e.g. “MAN
TNC Tanker Crude TNP Tanker Product TNV VLCC/ULCC CHM Chemical Tanker LPG/LNG Gas Tanker FSO / FPSO 14V52/55A” or “SULZER 5RTA58”
(3)
PAS Passenger Ship R/O Ro/Ro DRG Dredger NVL Naval Ship H/L Heavy Lift Reason of Sing Off, e.g. “EOC – End of Contract”, “MED –
OSV Offshore Supply SRV Survey vessel LOG Log/Timber SSHL Semi-Submergible MOB Mobile Offshore Unit Medical Ground”, “OWN – Own request”

Please provide details of recent employers who we

may contact for references
Name of Company COLUMBIA SHIPMANAGEMENT
Name of person to KOTE SHELIA
contact
Address

Telephone/E-Mail

Sea Service History and Experience

Time in Rank: 10 Months and 04 Days
Total Experience: 27 Months and 01 Days
Page 3 of 3 CV – Application Form