Матрос 1 класса (AB) в Москве

APPLICATION FOR SHIPBOARD EMPLOYMENT
RECORD OF FULL DATA
RANK: _AB________________________________ DATE: _13.03.2017____________ NATIONALITY: RUSSIAN
(position applied)

Full name :_GAYSIN ILSHAT______________ГАЙСИН ИЛЬШАТ ГАБДУЛНУРОВИЧ______________________________ _______________________________________________
(ENGLISH) ( RUSSIAN)

Date of birth_21.01.1976_________ Place of birth: USSR/ТАТАРСКАЯ АССР____________________________________________________
( IN ENGLISH / RUSSIAN FROM SEAMAN’S PASSPORT)
Place of birth: RUSSIA,TATARSTAN,ELABUGA_________________________________________________________________________
( IN ENGLISH FROM INTERIOR PASSPORT)
Father’s name: GABDULNUR____________________________Mother’s name: SOFIA______________________________

Home address: 12,PROLETARSKAYA str.,apt.83, ELABUGA city, TATARSTAN, RUSSIA________________________________________________________________________

PhoneNo: +7(85557)33040__________________Mobile+7(952)2233778____________________

Civil status: Single ( + ) Married ( ) Divorced ( ) Widower ( ) No. of children:_NO______

Name of next of kin: GAYSINA SOFIA_________________________________________ Relationship: MOTHER _______________
( Person to be notified in case of emergency)
Address of next of kin: 12,PROLETARSKAYA str.,apt.83,ELABUGA сity, TATARSTAN, RUSSIA __________________________________________________________________
Phone of next of kin: +7(85557)33040__________________________________

Educational background Nr of school Year (entered - completed)
Secondary school ELABUGA_______№6_______________ 1983-1993_____________________________
College St. Petersburg River Navigation College 1997-2000_____________________________ _____________________________
Highest educational attainment Admiral Makarov State University____2000-2002_________________________ _____________________________
Licence Nr: 90 БА 0616773_______ Place St. Petersburg _____________Date 05.05.2009________ Valid to_______
Endorsement Nr: 1014109175___________ Place ST.PETERSBURG ___________Date _27.01.2014________Valid to_______
Interior passport Nr:9207 447777____________________ Place ELABUGA,RUSSIA_______________________Date 10.06.2008________
Seaman’s passport Nr: RUS 0026985 _ Place FSI BOLSHOY PORT ST.PETERSBURG_Date 24.01.2013_Valid to 23.01.2018_
Foreign passport Nr:71 1784534__ Place_ФМС 16009__Date 27.08.2010_ Valid to_27.08.2020______

VISA/ Valid to:_PANSTWA SCHENGEN 03.08.2013-22.08.2013 TRANZYT___________________________________________________________________________
Any flag state’s license/ Valid to:______________________________________________________________
English level: _ read and translate with a dictionary ____________________________ Other languages: _french______________________________

Certificates Number Date issued Place issued Valid to
STCW 78/95 section A –VI/I (PSASR)Basic training 402733 07.09.2012 TC “MARSTAR”
St. Petersburg 07.09.2017
Advanced fire fighting
Proficiency in survival craft AA 0431639 20.062014 TC “MARSTAR”
St. Petersburg 20/06/2014
Health Certificate 17/03/2016 Medical Center”Hippocrat+”
Rostov-oDon 17/03/2017

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Please enumerate below your sea experience. Employment Record For Last Five Years
Name: _GAYSIN ILSHAT__________________________________________________________

Type and Name of Vessel DWT / Engine BHP makers Company’s name Phone No / Crewing Agents’ Name Position Period of service
From / To Reason of discharge
STS”MIR” 2257r.t./6AL Sulzer 2*419k.W. Admiral Makarov State University OS 05.08.2013/05.11.2013
ICEBREAKER”KAPITAN NIKOLAEV” 14264t./6*3040k.W. ROSMORPORT AB 30.01.2014/25.03.2014
DRY CARGO VESSEL ”SORMOVSKIY-3054” 3041t./2*6NVDS48A2V 1280k.W. North-Western Shipping Co AB 11.07.2014/02.11.2014
DRY CARGO VESSEL”RUSICH-1” 4970t./2*6L20C2
2280k.W. North-Western Shipping Co AB 13.04.2015/17.09.2015
DRY CARGO VESSEL”RUSICH-5” 4970t./2*6L20C2
2280k.W. North-Western Shipping Co +78123803121 SERGEY NIKOLAEVICH KHARKOVSKIY AB 24.03.2016/15.08.2016

STS”MIR” 2257r.t./6AL Sulzer 2*419k.W. Admiral Makarov State University OS 05.08.2013/05.11.2013
ICEBREAKER”KAPITAN NIKOLAEV” 14264t./6*3040k.W. ROSMORPORT AB 30.01.2014/25.03.2014
DRY CARGO VESSEL ”SORMOVSKIY-3054” 3041t./2*6NVDS48A2V 1280k.W. North-Western Shipping Co AB 11.07.2014/02.11.2014
DRY CARGO VESSEL”RUSICH-1” 4970t./2*6L20C2
2280k.W. North-Western Shipping Co AB 13.04.2015/17.09.2015
DRY CARGO VESSEL”RUSICH-5” 4970t./2*6L20C2
2280k.W. North-Western Shipping Co +78123803121 SERGEY NIKOLAEVICH KHARKOVSKIY AB 24.03.2016/15.08.2016