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APPLICATION FORM |
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| Name: Aleksandr | Surname: Gazarian | ||||||
| Date of birth: 11.07.1980 | Place of birth: Nikolaev | ||||||
| Permanent address: Nikolaev, Ukraine | |||||||
| Passport (OVIR): EE 193760 | Place of issue: Nikolaev | Date of issue: 24.06.2008 | Valid until: 24.06.2018 | ||||
| Seaman’s book: AB 358453 | Place of issue: Nikolaev | Date of issue: 26.07.2008 | Valid until: 26.06.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Gazarian Alena | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Nikolaev Marine School | Seaman | . | 1998 | ||||
| Nikolaev Seafarers' Training Centre | Seamen | . | 2007 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00519/2008/07 |
Nikolaev |
04.07.2008 |
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| Endorsement STCW |
00519/2008/07 |
Nikolaev |
04.07.2008 |
04.07.2013 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
06636/2008/42/01 |
Nikolaev |
11.06.2008 |
11.06.2013 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
05271/2008/42/02 |
Nikolaev |
11.06.2008 |
11.06.2013 |
| Carriage of dangerous and hazardous substances |
03547/2008/42/20 |
Nikolaev |
11.06.2008 |
11.06.2013 |
Sea service (during five last years):
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Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| Deva Maria |
Nikolaev River Port |
2100 |
Ukraine |
Dry cargo |
Seaman |
06.2007 |
09.2008 |
| Suerte |
Mariteam Services Inc |
22260 |
Malta |
Dry cargo |
OS |
10.2008 |
04.2009 |
| Experience at sea: Since 2007 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ 0826 | Issued: 08.2009 | Place: Nikolaev | Exp.date: 08.2010 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 09.2018 | |||
Ready to work from: any time