APPLICATION FORM
PP
Personal Data
Family
name: Vachev
|
First
name: Stefan
|
Middle
name: Mirchev
|
Rank: Master
|
Date & place of birth: 21.04.1955-Dimitrovgrad
|
Marital Status: married
|
Address: Bulgaria,Varna,Sekvoia str.11,entr.E,Fl.7,ap.16
|
Telephone No: +359-52-750714
Mobile No: +369-898-756554
|
Education: university
|
E-mail:stefan_vachev1955@abv.bg
|
Next of Kin Name/relationship:
Petia Georgieva Vacheva - wife
|
Nearest international airport: Varna
|
Availability for service: 15.12.2015
|
Hair: brown
|
Eyes: brown
|
Height: 176
|
Distinguished marks:
|
Passport No: 382812484
|
Issue place/country: Varna/Bulgaria
|
Expire date: 21.07.2019
|
Seaman’s book No: 500814779
|
Issue place/country: Varna/Bulgaria
|
Expire date: 18.07.2019
|
C1/D US Visa: N/A
|
Issue date:
Expire date:
|
Yellow fever:
|
Expire date: 20.04.2016
|
STCW95 certificates of issuing country
Licenses/certificates (STCW 95)
|
Number
|
Issue place/country
|
Issue date
|
Expire date
|
Licence: Master of ships of 3000GT or more Reg:21117/22.11.2006
|
5606484
|
Varna/Bulgaria
|
14.01.2014
|
07.08.2016
|
IV/2 GMDSS
|
21117
|
Varna/Bulgaria
|
19.02.1999
|
-
|
V/1-1 Tanker Familiarization
|
21117
|
Varna/Bulgaria
|
27.05.1999
|
-
|
V/1-2 Oil Tanker Operations
|
21117
|
Varna/Bulgaria
|
17.05.2013
|
16.05.2018
|
VI/2.1 Survival Craft & Rescue Boat
|
21117
|
Varna/Bulgaria
|
04.08.2011
|
03.08.2016
|
VI/3 Advanced Fire Fighting
|
21117
|
Varna/Bulgaria
|
17.05.2013
|
16.05.2018
|
VI/4-1 First Medical Aid Level 2
|
21117
|
Varna/Bulgaria
|
17.05.2013
|
16.05.2018
|
VI/4-2 Medical Care Level 3
|
21117
|
Varna/Bulgaria
|
23.05.2013
|
22.05.2018
|
VI/1 Basic Safety
|
-
|
-
|
-
|
-
|
VI/5 Ship Security Officer
|
21117
|
Varna/Bulgaria
|
17.05.2013
|
-
|
VI/6-2 Designated Security
|
-
|
-
|
-
|
-
|
VI/6-1 Security Awareness
|
-
|
-
|
-
|
-
|
Previous sea experience
Vessel Name
|
Flag
| Type |
DWT
|
Type Eng
|
Power
|
Company
|
Rank
|
From
|
Till
|
HADIYAH
|
Kuwaiti
|
tanker
|
121109.2
|
-
|
10511
|
KOTC
|
master
|
25.01.2015
|
19.04.2015
|
ARABIYAH
|
Kuwaiti
|
tanker
|
121109.2
|
-
|
10527
|
KOTC
|
master
|
15.08.2014
|
12.12.2014
|
ARABIYAH
|
Kuwaiti
|
tanker
|
121109.2
|
-
|
10527
|
KOTC
|
master
|
23.01.2014
|
07.05.2014
|
ARABIYAH
|
Kuwaiti
|
tanker
|
121109.2
|
-
|
10527
|
KOTC
|
master
|
27.07.2013
|
26.10.2013
|
AL DEERAH
|
Kuwaiti
|
tanker
|
35643.6
|
-
|
6715
|
KOTC
|
master
|
19.11.2012
|
07.03.2013
|
AL DEERAH
|
Kuwaiti
|
tanker
|
35643.6
|
-
|
6715
|
KOTC
|
master
|
20.04.2012
|
26.08.2012
|
Личните ми данни съдържащи се в настоящия формуляр, както и копията на документите описани по-горе предоставих доброволно. Декларирам, че давам съгласието си, личните ми данни да се обработват от Старнав ООД и при нужда да бъдат предоставяни на трети лица с цел наемането ми на работа, в съотвествие с чл.4, ал.1 т.2, чл.5, ал. 2 т.2 и чл.36а, ал.6 от ЗЗЛД, за което се подписвам по-долу.
Date: 15.12.2015 Signature:
OF 014 Revision 02 Page 1 of 1
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