AP P L I C AT I O N F O R M PHOTO

1 Position identity card PIN Number 1KBVTP5

Position Applied for: Officer in charge of an engineering watch

Date Available from: -

2 Personal Information Gender: Male

First Name: ELVIN Last Name: GASIMOV

Date of Birth: 10.12.1986 Place of Birth (City and Country): Azerbaijan, LANKARAN
Email: gasimov341@gmail.com
Mobile Number: (+994) 50 341 00 33 ; (+994) 55 404 37 34

Permanent Address: Garmatuk settlement, Expected Salary Per Month: -

Lankaran district, Azerbaijan
Nationality: Azerbaijan
Alternative rank applying for: -
Person to call in emergency: (+994) 50 335 04 35 Brother

3 Family Details: (If Unmarried kindly give details of Father / Mother)

First Name Last Name Gender Relation Contact

Tusi Gasimov Male Brother +99450 335 04 35

4 Maritime Education

Type of degree or
Name of school Country From To
diploma
Kiev State Marine Ukraine 2013 2017 Bachelor
Academy

5 Physical Data

Height 172

Weight 90

Boilersuit Size 2XL

Shoes Size 43

Blood group O(I)RH+

Additional Physical Information:{You can write any other information you want to add about your physique in this field.}

6 Seaman`s Book & Identify Docs

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 DATE OF
DOCUMENT COUNTRY NUMBER DATE OF ISSUE PLACE OF ISSUE
EXPIRY
Seaman Book Azerbaijan DQK 019925 20.04.2022 Azerbaijan 20.04.2027
Certificate of
Azerbaijan 0008446 21.04.2025 Azerbaijan 21.04.2030
Competency
Republic of
Azerbaijan C03881754 31.03.2022 Azerbaijan 30.03.2032
Azerbaijan

Record book USA MH1055486 08.08.2024 Azerbaijan 07.08.2029

Do you hold a US Visa ‘C1/D’? YES/NO NO Issue Date: - Expiry Date: -
Do you hold a US Visa ‘B1/B2’? YES/NO NO Issue Date: - Expiry Date:-
Have you been rejected for any visa applied for? YES/NO NO
If YES, please state the country and reasons -

7 Professional Test

Professional Test Date Name of Test Score

- - -

8 License

Name Issuing Country Certificate Number Valid Until

National endorsement of - - -
certificate of competency (if
issued)
- - -
Flag State Endorsements

9 STCW Certificates & Trainings

Training Date Of
Courses Issued Country Certificate No. Date Issued
Center Expiry
PERSONAL SURVIVAL TECHNICS Azerbaijan SO-1286-21 SMPA 23.06.2021 23.06.2026
FIRE PREVENTION & FIRE FIGHTING Azerbaijan SO-1286-21 SMPA 23.06.2021 23.06.2026
ELEMENTARY FIRST AID Azerbaijan SO-1286-21 SMPA 23.06.2021 23.06.2026
PERSONAL SAFETY & SOCIAL RESPONSIBILITY Azerbaijan SO-1286-21 SMPA 23.06.2021 23.06.2026
SAFETY FAMILIARIZATION TRAINING Azerbaijan SO-1286-21 SMPA 23.06.2021 23.06.2026
International Safety Management Azerbaijan SP-0694-23 SMPA 01.03.2023 01.03.2028
Proficiency in Survival Craft & Rescue SL-0702-23 SMPA 24.02.2023 24.02.2028
Boats
Azerbaijan
Security Awareness Training For All SI-0698-23 SMPA 02.03.2023 02.03.2028
Seafarers
Azerbaijan
Security Training For Seafarers With SH-0376-23 SMPA 22.02.2023 22.02.2028
Designated Security Duties
Azerbaijan
Eugenie-room resource management Azerbaijan ER-0028-25 SMPA 24.01.2025 24.01.2030
Basic training and qualifications on oil SA-0274-21 SMPA 01.09.2021 01.09.2026
and chemical tanker cargo operations;
Azerbaijan
Medical First Aid Azerbaijan SN-0082-25 SMPA 10.02.2025 -
Advanced Training in Fire Fighting Azerbaijan SJ-0074-25 SMPA 31.01.2025 31.01.2030
Leadership & Teamwork Azerbaijan DL-0073-25 SMPA 13.02.2025 07.02.2030
Dangerous,hazardous and harmful SK-0307-25 SMPA 21.02.2025 21.02.2030
cargoes
Azerbaijan
1000v Azerbaijan DM-0044-25 SMPA 14.02.2025 14.02.2030

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10 Seagoing Experience
9 (Please give a full record starting with the last vessel on which you served)

Name of Vessel’s Eng To Total REASONS FOR

COMPANY Flag DWT GRT TEU Rank From m/d/y
vessel Type Type m/d/y m/d S/OFF

CASPIAN M/V GILAVAR Azerbaijan Seismic 1400 Rolls- 3779 - A/B 25.07.2011 19.03.2014 2 years End of Contract
GEO Research Royce
Vessel
CMS M/V GURBAN Azerbaijan Crane 3343 21497 - A/B 09.09.2014 03.08.2015 11 months End of Contract
ABBASOV Vessel

CASPIAN M/V GILAVAR Azerbaijan Seismic 1400 Rolls- 3779 - A/B 11.08.2015 03.08.2016 1 years End of Contract
GEO Research Royce
Vessel
GEOKINETI M/V TZ-418 Azerbaijan Seismic - - - - A/B 03.05.2016 03.01.2017 8 months End of Contract
CS Research
COMPANY Vessel
PALMALI M/V Palau Dry Cargo 6933 Wartsila 5684 - Motorman 14.05.2018 23.10.2018 6 months End of Contract
SHIPPING NAKHCIVAN Ship

CONSUL M/V CONSUL Tanzania Dry Cargo 3436 - 2827 - Motorman 27.09.2021 29.03.2022 6 months End of Contract
SHIPPING Ship
LIMITED

CASPIAN M/V GILAVAR Azerbaijan Seismic 1400 Rolls- 3779 - Motorman 15.06.2022 30.12.2023 7 months End of Contract
GEO Research Royce
Vessel
CASPIAN M/V GILAVAR Azerbaijan Seismic 1400 Rolls- 3779 - Motorman 20.01.2024 30.06.2024 6 months End of Contract
GEO Research Royce
Vessel
AURORA M\V AURORA Marshall General 9530 Mitsubis 6030 - Motorman 06.08.2024 30.12.2024 4m 24d End of Contract
ONE ONE Cargo hi
SHIPPING akasaka

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11 For Engineers (Please provide details)
-
Generators
Purifiers and Boilers -

Type of Cranes / No of Reefer

-
Containers

12 Other Experience

Russian Language: Good

English Language : Middle

12 Travel Documents

Name YES/NO Country Date pf Expire

Schengen YES/NO NO -
US YES/NO NO -
China YES/NO NO -
Australia YES/NO NO -

13 Insurance ,Health Related Documentation

Medical Certificate (Fit for Duty) YES/NO YES
Vaccination
Yellow Fever YES/NO NO
COVID-19 YES/NO YES

(If the answer is YES to any of the above, please give full details and attach a separate page if necessary)

14 Medical history
Have you ever signed off a ship due to medical reasons? YES/NO NO
Have you undergone any operation in the past? YES/NO NO
Have you consulted a doctor during the last 12 months for an illness/accident? YES/NO NO
Do you have any health or disability problems now? YES/NO NO
Do you take any medications regularly? YES/NO NO

(If the answer is YES to any of the above, please give full details and attach a separate page if necessary)

15 General

Have you ever been the subject of a court of enquiry or involved in a maritime accident? YES/NO NO
Have you ever had a professional license suspended or revoked? YES/NO NO

(If YES, please give full details and attach a separate page if necessary)

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16 References (Please give the name and address of your current or immediate past employer)

Name of company 1.- 2.-

Name of person to contact - -
Address - -
 No. - -

17 Declaration

I hereby declare that the above particulars are true and authorize you to contact the referees listed above.

I have read it, I am familiar with it, I confirm with my signature.

Date: 28.04.2025
Signature

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