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Application form / personal data
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| Family Name: Lebedev | Name: Nikolay | |||||||||||
| Father’s Name: Vasiliy | Mother’s Name: Elena | Wife’s Maiden Name: | ||||||||||
| Date of Birth: 25/06/1988 | Place of Birth / City & Country: USSR | Citizenship: Russia | ||||||||||
| Height: 185 | Weight: 90 | Colour of eyes: Blue | Colour of hair: Blonde | |||||||||
| Permanent address: | Phone (home): +4012588394 | |||||||||||
| 50-5, Stekolnaya str., Kaliningrad, Russia | Phone (business): +79114691773 | |||||||||||
| e-mail: nick_888.88@mail.ru Skype ID: | ||||||||||||
 married
 single x
 divorced
| Wedding date: | Next of kin (name, surname, kinship): | Address next of kin: | |||||||||
| Nr. of Children: | Phone: | Nearest airport: Khrabrovo | ||||||||||
| Religion: | Waist: (cm) | Chest: (cm) | Shoe size: | Collar: (cm) | ||||||||
POSITION APPLIED FOR:
| DOCUMENTS | NUMBER | ISSUED | VALID | CITY OF ISSUE | ||
| TRAVEL PASSPORT | 72 2899812 | 04.02.2013 | 04.02.2023 | Russia, Kaliningrad | ||
| ID CARD | 23.03.2016 | 22.03.2021 | Russia, Kaliningrad | |||
| LICENSE _______________ (GRADE) | 04.12.2015 | 16.05.2019 | Russia, Kaliningrad | |||
| ENDORSEMENT_________(GRADE) | 30.03.2016 | 12.02.2021 | Russia, Kaliningrad | |||
| TANKERMAN FAMILIARIZATION COURSE V/1 | 12.02.2016 19.02.2016 19.02.2016 | 12.02.2021 19.02.2021 19.02.2021 | Russia, Kaliningrad Russia, Kaliningrad Russia, Kaliningrad | |||
| TANKERMAN HIGHEST GRADE CERTIFICATE | LPG | |||||
| OIL | ||||||
| CHEM | ||||||
| COW (Crude Oil Washing) | ||||||
| Training of Seafarers with Designated Security Duties | 04.07.2014 | 04.07.2019 | Russia, Kaliningrad | |||
| SOLAS | 27.06.2014 | 27.06.2019 | Russia, Kaliningrad | |||
| Proficiency in Survival Craft & Rescue Boats | 21.05.2014 | 21.05.2019 | Russia, Kaliningrad | |||
| Advanced Training Fire FightingA-VI/3 | 16.05.2014 | 16.05.2019 | Russia, Kaliningrad | |||
| Designated security duties A-VI/6-2 | ||||||
| GMDSS | 16.11.2015 | 26.06.2020 | Russia, Kaliningrad | |||
| RADAR OBS | 3.07.2015 | 3.07.2020 | Russia, Kaliningrad | |||
| ARPA | ||||||
| MEDICAL CAREA-VI/4-2 | ||||||
| MEDICAL FIRST AIDA-VI/4-1 | 30.05.2014 | 30.05.2019 | Russia, Kaliningrad | |||
| YELLOW FEVER VACCINATION | 29.02.2016 | 29.02.2026 | Russia, Kaliningrad | |||
| HEALTH CERTIFICATE | 14.04.2016 | 28.07.2017 | Russia, Kaliningrad | |||
| VISA SCHENGEN | 03.04.2014 | 02.04.2017 | Russia, Kaliningrad | |||
| USA VISAC1/D | ||||||
| OTHER SEAMAN’ S BOOK | ||||||
| OTHERS DOCUMENTS | ||||||
SEA SERVICE:
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