APPLICATION FORM
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APPLICATION FORM |
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| Name: Maksym | Surname: Anishchenko | ||||||
| Date of birth: 18.04.1983 | Place of birth: Odessa | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AT 286994 | Place of issue: Odessa | Date of issue: 26.03.2002 | Valid until: 26.03.2012 | ||||
| Seaman’s book: AB 366738 | Place of issue: Odessa | Date of issue: 20.10.2008 | Valid until: 20.10.2012 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Nadezhda Anishchenko | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Odessa Maritime College | Engineering | 2003 | |||||
| Odessa National Maritime Academy | Engineering | 2008 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00675/2008/08 | Odessa |
13.08.2008 |
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| Endorsement STCW | 00675/2008/08 | Odessa |
15.08.2008 |
23.05.2013 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 1686/2008 | Odessa |
23.05.2008 |
23.05.2013 |
| Advanced Fire Fighting (A-VI/3) | 0930/2008 | Odessa |
23.05.2008 |
23.05.2013 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 1431/2008 | Odessa |
23.05.2008 |
23.05.2013 |
| Medical First Aid (A-VI/4-1) | 0586/2008 | Odessa |
23.05.2008 |
23.05.2013 |
| Maintenance of Electrical and Electronic Engineering | 0452/2008 | Odessa |
11.07.2008 |
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| Passenger ships other than Ro-Ro (A-V/3) | 0330/2008 | Odessa |
09.07.2008 |
09.07.2013 |
| Bahamas Endorsement | LN 135598/00 | Bahamas |
23.09.2008 |
23.05.2013 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Astoria | Passat Shipmanagement | 3245 | Bahamas | Pass |
4-th Eng |
16.09.2005 |
23.05.2006 |
| 2. Astoria | Passat Shipmanagement | 3245 | Bahamas | Pass |
3-rd Eng |
12.09.2006 |
13.03.2007 |
| 3. Astoria | Passat Shipmanagement | 3245 | Bahamas | Pass |
2-nd Eng |
27.04.2007 |
07.09.2007 |
| 4. Astoria | Passat Shipmanagement | 3245 | Bahamas | Pass |
2-nd Eng |
08.11.2007 |
25.03.2008 |
| 5. Astoria | Passat Shipmanagement | 3245 | Bahamas | Pass |
2-nd Eng |
06.09.2008 |
03.01.2009 |
| 6. Albatros | V.Ships | 5123 | Bahamas | Pass |
2-nd Eng |
17.03.2009 |
03.08.2009 |
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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. A2 |
Man 6L40/45 |
4 |
4x4500 |
Man 9ASL25/30 |
1938/1425 |
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| 2. A2 |
Man 6L40/45 |
4 |
4x4500 |
Man 9ASL25/30 |
1938/1425 |
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| 3. A2 |
Man 6L40/45 |
4 |
4x4500 |
Man 9ASL25/30 |
1938/1425 |
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| 4. A2 |
Man 6L40/45 |
4 |
4x4500 |
Man 9ASL25/30 |
1938/1425 |
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| 5. A2 |
Man 6L40/45 |
4 |
4x4500 |
Man 9ASL25/30 |
1938/1425 |
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| 6. A2 |
Wartsila 6L38 |
4 |
4x5385 |
Mak 6M20 Vasa 6R32 |
1387/1020 2475/1820 |
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| Experience at sea: Since 2002 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 12.06.2012 | |||