Title: Form Manual
Operational Procedures Form
MSC CREWING SERVICES
MSC House, 92-v Lustdorfskaya road, Odessa 65088, Ukraine
Tel.: +38 (0482) 333 891
Fax.: +38 (048) 7055 200 / E-mail: info@[Link]
APPLICATION FORM
(Personal Data)
Position applied for _Deck Cadet_________ License hold ___________________ Date Available _20.10.2025_________
Family Name: Zozulin Name: Nikita Father's name: Yiriuovich
Date of birth: 17.09.2007 Place of birth: Izmail, Ukraine Nationality: Ukrainian Marital status: Single
Address: Izmail, Torgova 115 Nearest Airport: Henri Coanda
Home phone:
International Airport
E-mail: nikitazozulin2007@[Link] Mobile phone:+380 67 661 1450
Next of kin and relationship: Children (name & DOB):
Next of kin’s address: Next of kin tel: +380 97 090 9382
Inter. P’port No : Date of issue: Valid: Place of issue:
Seaman's book No: AC 014423 Date of issue: 18.03.2024 Valid: 18.03.2029 Place of issue: Ukraine
Civil P’port No : Date of issue: Place of issue:
USA visa No : Date of issue: Valid: Place of issue:
TOSE : Date of issue: MARLINS, %: Date of issue:
SEA GOING EXPERIENCE FOR THE LAST 7 YEARS
(MOST RECENT VESSEL LAST)
Year of Company Owner / Type of From To
Name of vessel Flag DWT / TEU ME type / Model BHP Rank
built Ship Manager vessel DD/MM/YYYY DD/MM/YYYY
Version 00/01 Feb 19 Page 1 of 2
Form CD-P03-1
Title: Form Manual
Operational Procedures Form
Name of Maritime Institution attended Address of institution From To Degree of Diploma
STCW Certificates Number Issued Valid Place of issue STCW Certificates Number Issued Valid Place of issue
Certificate of competency BRM or ERRM Course
Endorsement Basic safety for all seafarers 02146/2024 20.02.2024 20.02.2029 Ukraine
GMDSS Endorsement Advanced fire fighting
Radar obs./ARPA operator Prof. in survival craft
ECDIS course Fast rescue boat
Security officer (ISPS) Medical first aid
Security Designated Duties Medical care
Hazardous cargoes Training pers on [Link]
Prof. in ship security 933581 13.06.2025 Ukraine Prof. in familiarization 837467 12.06.2025 Ukraine
training on ship security
issues
Medical examination Issued: Valid: Weight, kg: 87 Height, cm: 180
Drug & alcohol test Issued: Valid: Eyes: Brown Hair: Black
Yellow fever Issued: 01.09.2025 Valid: Overall size: 60 Safety shoes: 46
Another States Rank Document No Issued Valid Another States Certificates of Rank Document No Issued Valid
Seamen’s Books competency
Liberia Liberia
Panama Panama
Please complete addresses of your previous employers for references
Version 00/01 Feb 19 Page 2 of 2
Form CD-P03-1
Title: Form Manual
Operational Procedures Form
Company Tel Company Tel
Address Address
Мій підпис підтверджує мою остаточну та безсуперечну згоду на обробку (збір, накопичення, зберігання, прийняття, систематизацію, використання, розподіл, поновлювання, змінення, знищення, кодування та будь-які інші
дії, необхідні для надавання посередницьких послуг з найму за кордоном і/або інших супровідних послуг) моїх особистих даних, що вказано в цій заявці з найму, а також будь-яких інших моїх особистих даних, що
надаються до ТОВ «ЕМ ЕС СІ КРЮЇНГ СЕРВІСЕС»
Signature____________________ Date _07.10.2025_________I understand, that my working contract will be canceled without notifying if any of submitted information and documents are voted as false.
Nationalities of crew sailed with:
Version 00/01 Feb 19 Page 3 of 2
Form CD-P03-1