“CH.P. TISCHENKO”

52, Ostryakova str. - of. № 330

299029Sevastopol,Crimea

Tel: +38-0692-45-17-12,+7-978-741-27-83,

+7-978-956-12-41

Skype: avtischenko2008

E-mail: web:www. Тищенко.com

APPLICATION FORM
Position applied for: Minimum acceptable salary:
Position applied for: / Date available:20.11.2014
Surname
name
Father's Name
Date and place of birth:
Address: / City: / Str.
Personal civil code: / House: Apt.: / Mob  +380
Mob  +380
E-Mail : / ICQ : / SKYPE :
TITLE OF THE DOCUMENT / INSTITUTION / PLACE / CERT.NO / DATE
ISSUED / VALID
UNTILL
Civil Passport
Travel. Passport
Seaman’s Book
Certificate of competency
Rank
Endorsement
Others Professional license
Rank
Endorsement
GMDSS (GOC) Certificate
GMDSS Endorsement
Radar Observer and Plotting
ARPA
Basic Safety (incl Pers.Safety & Social Resp.)
Medical First Aid or Medical Care
Basic Fire Fighting or Advanced Fire Fight.
Proficiency In Survival Craft & Rescue Boats
Fast Rescue Boats
Hazardous cargoes (solid and bulk)
Ship Security Officer( ISPS/SSO)
Bridge Team Management
Bridge Resources Management
Ship Handling Simulator
Electronic charts
ISM Code
Training on Ro-Ro Passenger ships
Training on Pass. ship other than Ro-Ro
Crowd Management
Oil Tanker Familiaris. or Specialized
Liq.Gas Tanker Familiaris. or Specialized
Chem. Tanker Familiaris. Or Specialised
C.O.W. / I.G.S.
Maintenance of electronic and electrical eqp.
Yellow fever Vaccination
Second (relative) specialty
Englishknowledge
Welding skills (навыки
Experience with mixed Nationality crew
ReasonforleavinglastCompany
ValidUSAvisa
SCHENGEN Visa
Other Visas

MARINEEDUCATIONRECEIVED

NAME OF SCHOOL / FROM / TILL / TYPE OF DEGREE RECEIVED

REFERENCES

NAME OF COMPANY / CREWING AGENT / CONTACTS

ADDITIONAL INFORMATION

Marital status:Married/Single
Wife/Mother/Father
(Name, First name, Date and place of birth)
Children under the age of 18 (names, date of birth )
Children under the age of 18 (names, date of birth )
Next of kin (Name, date of birth, address, phone #)
Physical details: / Height: / Weight: / Overall: / Shoes:

PREVIOUS SEA EXPERIENCE (FOR LAST 10 YEARS):

RANK / NAME OF THE VESSEL / TYPE VESSEL / YEAR OF BUILD / DWT / TYPE OF THE MAIN ENGINE / FROM / TILL / Owner COMPANY
FLAG / HP