APPLICATION FORM
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APPLICATION FORM |
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| Name: Igor | Surname: Kaznacheyev | ||||||
| Date of birth: 03.01.1971 | Place of birth: Sevastopol | ||||||
| Permanent address: Sevastopol, Ukraine | |||||||
| Passport (OVIR): AH 685922 | Place of issue: Sevastopol | Date of issue: 27.09.2001 | Valid until: 27.09.2011 | ||||
| Seaman’s book: AB 391186 | Place of issue: Sevastopol | Date of issue: 10.11.2008 | Valid until: 08.10.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Kaznacheyeva Marina | ||||||
| Supported children under age of 18 | 1. Kaznacheyeva Kristina - 24.05.2000 | ||||||
| (name, surname, date of birth) | 2. Kaznacheyeva Oksana - 09.10.2008 | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Sevastopol Marine School | Welder | 31.08.1989 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency (Welder) | 00126/2003/09 | Sevastopol |
05.11.2003 |
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| Endorsement STCW (Welder) | 00126/2003/09 | Sevastopol |
31.10.2008 |
03.10.2013 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 13198C | Sevastopol |
03.10.2008 |
04.10.2013 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 0317/2005 | Sevastopol |
17.08.2005 |
17.08.2010 |
| Certificate of competency (AB) | 00228/2003/09 | Sevastopol |
03.09.2009 |
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| Endorsement STCW (AB) | 00228/2003/09 | Sevastopol |
03.09.2009 |
04.10.2013 |
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Tanker Certificates |
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 2358C | Sevastopol |
03.10.2008 |
04.10.2013 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) | 2358C | Sevastopol |
03.10.2008 |
04.10.2013 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 2358C | Sevastopol |
03.10.2008 |
04.10.2013 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Hesnes | Tsakos Shipping & Trading | 68157 | Malta | Tanker |
Fitter |
10.09.2005 |
12.05.2006 |
| Mol Bravery | Mitsuy OSK line | 41114 | Panama | Container |
Fitter |
02.10.2006 |
08.04.2007 |
| Tropic Canada | Marlow Navigation | 19932 | Ant&Barb | Container |
Fitter |
18.06.2007 |
10.08.2007 |
| Swan | SMT | 38892 | Bahamas | Bulker |
Fitter |
04.09.2007 |
12.12.2007 |
| Blue Diamond | Ofer Ltd | 53521 | Liberia | Bulker |
Fitter |
28.01.2008 |
19.07.2008 |
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Experience at sea: Since 1989 |
Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | Issued: | Place: | Exp.date: | |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 26.01.2014 | |||