NARVAL Ltd.

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MURMANSK, Russia
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Crew Application
Position applied for 3eng Date of availability May-16
PART I. PERSONAL DESCRIPTION AND INFORMATION:
1. LAST NAME 2. FIRST NAME 3. MIDDLE NAME
Amosov Mikhail
4.DATE OF BIRTH 5.PLACE OF BIRTH 6.NATIONALITY 7.HEIGHT 8. WEIGHT 9. COLOUR OF EYES 10.COLOUR OF HAIR
3/31/1990 Murmansk RUSSIA 186 78 brown brown
11. HOME ZIP CODE CITY COUNTRY ADDRESS
ADDRESS: Murmansk RUSSIA Mira str. 23-54
12.HOME'S TELEPHONE NO. 13. MOBILE 14. CONTACT TELEPHONE NO. & E-MAIL ADDRESS 15. NORTH-WEST Yes / No
89095612121 [email protected] REGISTRATION
X □
16.MARITAL STATUS 17. NO. OF CHILDREN 18.NEXT OF KIN (RELATIONSHIP, NAME, SIGNATURE FOR ACKNOWLEDGEMENT)
Single mother,Amosova Vera
19.ADDRESS OF NEXT ZIP CODE CITY COUNTRY ADDRESS
OF KIN Murmansk Russia Mira str 23-54
20.TEL. OF NEXT OF KIN 89095612122
IF ADDRESS/TEL. OF NEXT OF KIN ARE THE SAME, PLS CLICK HERE X
PART II. PASSPORTS
PASSPORTS NUMBER PLACE OF ISSUE ISSUED ON VALID TILL
Seaman's book MK 0129857 Murmansk 9/17/2013
National Seaman's Passport
International Travel Passport 725,019,116 Murmansk 6/18/2013 6/18/2023
National Civil Passport 4,710,278,971 Murmansk 12/14/2010
PART III. VISAS
ISSUED ON VALID TILL ISSUED ON VALID TILL
Schengen visa
USA visa
German working visa
PART IV. NATIONAL CERTIFICATES OF COMPETENCY
LICENSE GRADE NUMBER PLACE OF ISSUE ISSUED ON VALID TILL
National Certificate of Competency OWW Engineering 2031605239 Astrakhan 11/19/2012 8/10/2017
National Certificate of Competency
PART V. FOREIGN DOCUMENTS PART VI. NATIONAL CERTIFICATES:
DOCUMENT GRADE NUMBER ISSUED ON VALID TILL CERTIFICATES ISSUED ON VALID TILL
GERMAN Seaman's book GMDSS (ROC / GOC)
Endorsement Endorsement of GMDSS
GMDSS Basic Training (SOLAS) 8/10/2012 8/10/2017
A&B Seaman's book Proficiency in Survival Craft 8/17/2012 8/17/2017
Endorsement Advanced Fire Fighting 8/23/2012 8/23/2017
GMDSS Medical First Aid 8/28/2012 8/28/2017
LIBERIAN Seaman's book Medical Care
Endorsement HAZMAT
Basic Training (SOLAS) HAZMAT (st. 49, USA)
Proficiency in Survival Craft ARPA
Advanced Fire Fighting Radar Observer
Medical First Aid Stability courses
NETH.ANT.Seaman's book Ship Security Officer (SSO) 8/21/2013 8/21/2018
Endorsement ECDIS
GIBRALTAR Endorsement Bridge team management
MADEIRA Endorsement English courses
ST.VIN&GR. Endorsement Med. Examination
MALTA Endorsement Yellow Fever
Drug & Alcohol test
REMARKS:

DATE OF APPLYING SIGNATURE

PART VII. SEA SERVICE RECORD: List and submit proof of sea service during the last 5 (five) years
PERIOD OF SERVICE TOTAL SERVICE
NAME OF CREWING AGENCY / SHIPPING
RANK VESSEL TYPE NAME OF VESSEL GT / ENGINE TYPE / KW FLAG FROM TO
COMPANY * YY MM DD
DD MM YY DD MM YY
4Eng Bulker Pavel Vavilov 16253/Man/8238 Russia MSCO 17 9 2013 30 1 2014 4 13
4Eng Bulker Zapolyarye 15868/Man B&W/9480 Russia MSCO 21 7 2014 20 11 2014 4 0
3Eng Seismic survey Vessel Akademik Namchinov 3224/Mak/3840 Russia SMNG 9 6 2015 17 9 2015 3 8
3Eng Seismic survey Vessel Akademik Shatskiy 3224/Zgoda-Sulzer/3711 Russia SMNG 21 12 2015 1 3 2016 3 10

* Please provide contact details of ex.employers:

PART VIII. NAUTICAL, ENGINEERING OR RADIO SCHOOL AS ATTENDED:
DATES ATTENDED
NAME OF SCHOOL ADDRESS TYPE OF DEGREE OF DIPLOMA RECEIVED UPON GRADUATION
FROM TO

PART IX. APPLICANT'S DECLARATION

Please answer the following questions Yes / No Please provide details. FOR OFFICE USE ONLY
Salary expectation? 3500$ ENGLISH LEVEL
Did you terminate your contracts? Reasons no
Have you been dismissed before? What for? no SUITABILITY YES NO
Have you been refused entry by any country? Which? no VESSEL/ENGINE TYPE - -
Any medical restrictions / drugs / allergies? no
Any past history medical / mental condition? no CRANE EXPERIENCE
Experience in mixed crew? Which nationalities? yes Norwegians
Number of crewmembers on board? 20 TIMBER CARRIERS
Have you crane/heavy lifts experience? S.W.L.? yes 8tonns
Had been there pontoons, portable bulkheads on board? no HEAVY LIFTS
Are you familiar with computer? yes
Do You have welding or lacing machine experience? no COASTERS
For cooks: What kind of cuisine can you cook?
For Engineers: number of Engineers in Engine Room? 4 REMARKS
Type of Engines did you worked? Man,Mak,Wartsila,Zulzer
Experience with heavy fuel oil? Which Engine types? yes Man
Experience with 2 stroke engines? yes
For Officers: number of officers on board?
Had been there ECDIS on board? no
Had been there bow thrusters on board? yes

I certify that the information given by me herein are true and correct to the best of my knowledge. Any false information may be subjected to legal actions and voiding of any
benefits arising from my employment contracts. Name, Signature of applicant