APPLICATION FORM
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APPLICATION FORM |
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| Name: Aleksandr | Surname: Akulin | ||||||
| Date of birth: 21.05.1976 | Place of birth: Nizhniy Novgorod | ||||||
| Permanent address: Nizhniy Novgorod, Russia | |||||||
| Passport (OVIR): 4418683 | Place of issue: N.Novgorod | Date of issue: 29.06.2005 | Valid until: 29.06.2010 | ||||
| Seaman’s book: 0256675 | Place of issue: N.Novgorod | Date of issue: 18.07.2007 | Valid until: 18.07.2012 | ||||
| Citizenship: Russia | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Akulina Maria | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| VGAVT N.Novgorod | Engineer | 04.2000 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 1011201160 | St.Petersburg |
10.10.2007 |
13.08.2010 |
| Endorsement STCW | 1011201160 | St.Petersburg |
10.10.2007 |
13.08.2010 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 040679 | N.Novgorod |
13.08.2005 |
13.08.2010 |
| Advanced Fire Fighting (A-VI/3) | 019700 | N.Novgorod |
20.08.2005 |
20.08.2010 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 038984 | N.Novgorod |
17.08.2005 |
17.05.2010 |
| Medical First Aid (A-VI/4-1) | 022321 | N.Novgorod |
25.08.2005 |
25.08.2010 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Ruslan | Mar ship | 2950 | Russia | Cargo |
3-rd Eng |
07.2002 |
01.2003 |
| 2. Ruslan | Mar ship | 2950 | Russia | Cargo |
3-rd Eng |
07.2003 |
03.2004 |
| 3. Bratsk | Mar ship | 3000 | Russia | Cargo |
3-rd Eng |
10.2004 |
04.2005 |
| 4. Bratsk | Mar ship | 3000 | Russia | Cargo |
2-nd Eng |
11.2005 |
03.2006 |
| 5. Bratsk | Mar ship | 3000 | Russia | Cargo |
2-nd Eng |
10.2006 |
04.2007 |
| 6. Argo-1 | Mar ship | 3000 | Belize | Cargo |
2-nd Eng |
10.2007 |
12.2007 |
|
Automation (A1/A2) |
Main Eng. Maker/Model |
Engine Stroke |
Engine Total HP |
Aux. Engine Maker/Number |
Aux. Engine H.P. / KW |
Unmanned |
Without El.Eng. |
| 1. A3 |
SKL |
4 |
2*700 |
K-462 |
70/50 |
|
with |
| 2. A3 |
SKL |
4 |
2*700 |
K-462 |
70/50 |
|
with |
| 3. A3 |
SKL |
4 |
2*700 |
K-462 |
70/50 |
|
with |
| 4. A3 |
SKL |
4 |
2*700 |
K-462 |
70/50 |
|
with |
| 5. A3 |
SKL |
4 |
2*700 |
K-462 |
70/50 |
|
with |
| 6. A3 |
SKL |
4 |
2*700 |
K-462 |
70/50 |
|
with |
| Experience at sea: Since 1999 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ 1868 | Issued: 27.09.2007 | Place: Rostov | Exp.date: 27.09.2008 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||