Загрузил gribanov-2017

anketa-green-reffers

реклама
29A, Oktyabrskaya str.,Kaliningrad,
236006, Russia
Phone: (+74012) 360465
Fax: (+74012)360348
E-mail: cv-kgd@greenreefers.com
http://www.green-management.ru/
APPLICATION FORM
PHOTO
Position applied for:
1
Date available:
OS
7/06/2022
(Last Name) Gribanov
(First names):
Date/place of birth:
05/07/2003
Permanent address:
Street: Tobolskaya 35-6
Danila
Nationality:
Post code:
 Mailing address:
235006
City:
@ E-mail:
 No.:
 No.:
89506729648
89506729648
Height (cm):
Colour of eyes:
Marital status:
Nearest airport:
Skype address:
186
Green
Single
khrabrovo
Weight (kg):
Colour of hair:
Father’s name:
75
Blond
Education Background
School / College
From
KMFC
19
To
2022
Highest Qualification Attained
Navigation department
Identity documents
DOCUMENT
Travel passport:
Seaman’s passport
Seafarer’s Identity Document
Seaman’s book:
Country
National
National
National
National
Number
753557680
MK0337632
Issued date
09.08.2016
09.04.2021
Expiry date
09.08.2026
RUS0501185
31.03.2021
30.03.2026
Do you hold a US Visa ‘C1/D’?
Have you been rejected for any visa applied for?
If YES, please state the country and reasons
Do you hold Schengen visa?
YES
YES
NO +
NO +
Valid until:
YES
NO+
Valid until:
Place
Г.Калининград
Морской
Порт.Калининград
Next of kin
Name:
Relationship:
Address:
 No.:
5
Kaliningrad
City:
Gribanov-2017@list.ru
Mobile phone:
4
Rus
Street:
Post code:
3
1250
Personal details
Name:
2
Min salary USD:
(Last Name): Semenkova
Mother
СНТ юбилейный. Цветочная 82
Post code:
Home:
(First Names) : Natalya
City:
Mob.
Kaliningrad
89506729648
Health Certificates
Issue date
International Health Cert.
Vaccination against Yellow fever
Drug & Alcohol test
Expiry date
6
Certificates of competency
Class / Grade
7
Number
Issue date
Expire date
RUS1525274
Number
16.10.2020
16.10.2025
RUS1520817
20.10.2020
20.10.2025
Fluent
Issued by
Very good
Good
Poor
+
+
+
Bank account information (optional)
Bank Name:
Address:
Account No.:
Swift code:
Owner name:
Owner address:
10
References (Please give the name and address of your current or immediate past employer)
Name of company:
Name of person to contact:
Address:
 No.:
10a
Expire date
Issued at
Languages
English
9
Issue date
Courses attended and certificates obtained
Course name
Basic safety training (SOLAS)
Advance Fire Fighting
Elementary First Aid
Medical First Aid
Medical Care
Personal Survival Techniques
Personal Safety & Social Responsibility
Proficiency In Survival Craft
GMDSS
ARPA
Radar
Ship Security Officer Course
Seafarers with Designated Security
Duties
Other:
8
Place / Country Issued
References
Name of company:
Name of person to contact:
Address:
 No.:
Satisfactory
11
Sea service
9
Record of previous service
(Please give a full record starting with the last vessel on which you served)
VESSEL NAME
FLAG
OWNER NAME
VESSEL
TYPE
Norne
Nor
General Cargo
AtlantNiro
Rus
Fishing Vessel
##
12
RANK
Deck
Cadet
OS
SIGNED
ON
SIGNED
OFF
18.05.202
2
25.04.202
2
30.07.202
1
25.05.202
2
ME TYPE
GRT/BHP
Required for engineer applicants only
Declaration
I hereby declare that the above particulars are true and authorise you to contact the referees listed above.
In connection with the Law of 29.08.1997 "On Protection of Personal Data" herewith I do agree to the storage and processing
my personal data submitted in the company Green Management Sp. z o. o. At the same time I agree to share same with foreign
ship owner under the measures aimed at my employment. I am ensured that I have the right to inspect and correct the data.
В соответствии с Федеральным законом РФ от 27.06.2006 №152-ФЗ «О Персональных данных», я даю согласие на
обработку, трансграничную передачу и хранение указанных в анкете персональных данных, а также персональных
данных, представляемых мною при заключении контракта.
Оператор обработки данных : ООО «Грин Менеджмент»
Цель обработки – добавление ПД в базу данных, предоставление вакансий, трудоустройство .
Date:
Signature
30.05
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