APPLICATION FORM
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APPLICATION FORM |
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| Name: Oleksandr | Surname: Anysymov | ||||||
| Date of birth: 08.07.1973 | Place of birth: Izmail | ||||||
| Permanent address: Izmail, Ukraine | |||||||
| Passport (OVIR): EA 096918 | Place of issue: Izmail | Date of issue: 03.08.2007 | Valid until: 03.08.2017 | ||||
| Seaman’s book: AB 350471 | Place of issue: Izmail | Date of issue: 03.04.2006 | Valid until: 03.04.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 09.12.2012 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Aniisimova Olga | ||||||
| Supported children under age of 18 | 1. Anysymova Mariya, 20.10.2006 3. Anysymova Diana, 25.09.2007 | ||||||
| (name, surname, date of birth) | 2. Anysymova Katerina, 20.10.2006 | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kiev State Maritime Academy | Engineer | 23.09.2009 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00883/2009/01 | Izmail |
23.09.2009 |
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| Endorsement STCW | 00883/2009/01 | Izmail |
23.09.2009 |
08.09.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 01674 KT | Kiev |
15.10.2006 |
15.10.2011 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 3617/07 | Odessa |
09.10.2007 |
09.10.2012 |
| Advanced Fire Fighting (A-VI/3) | 6362 KT | Kiev |
23.09.2006 |
23.09.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 01674 KT | Kiev |
15.10.2006 |
15.10.2011 |
| Medical First Aid (A-VI/4-1) | 01375 KT | Kiev |
08.09.2006 |
08.09.2011 |
| Maintenance of Electrical and Electronic Engineering | 2/060/09 | Illichivsk |
25.08.2009 |
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| Malta Endorsement | 83869 | Malta |
16.12.2009 |
08.09.2011 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 2. Tinsdal | Marlow | 2400 | Antigua | Bulker/Cont |
AB/motorman |
20.08.2005 |
02.02.2006 |
| 3. Parma | Marlow | 2400 | Antigua | Bulker/Cont |
AB/motorman |
07.04.2006 |
01.08.2006 |
| 4. Hanseatic spring | Marlow | 2200 | Antigua | Bulker/Cont |
AB/motorman |
10.11.2006 |
22.05.2007 |
| 5. Greta | Marlow | 2400 | Antigua | Bulker/Cont |
motorman |
10.10.2007 |
13.11.2007 |
| 6. Funky | Orion Shipping | 2248 | St.Vincent | Cargo/Cont |
3-rd Eng |
29.11.2007 |
17.04.2008 |
| 7. Safmarine Saloum | Reederei Rambow | 13805 | Antigua | Cont |
3-rd Eng |
21.04.2008 |
05.10.2008 |
| 8. Saint Demetrios | Cleopatra Shipping Ltd | 17100 | Panama | Gen cargo |
3-rd Eng |
02.02.2009 |
05.08.2009 |
| 9. Sukriye | Unimarin | 2834 | Malta | Cargo/Cont |
2-nd Eng |
25.10.2009 |
27.04.2010 |
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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. |
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| 6. A2 |
Man B&W |
2 |
2448 |
SKL |
/170 |
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no |
| 7. A1 |
Man B&W 7L58/64 |
4 |
9730 |
Man B&W |
/620 |
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no |
| 8. A1 |
Pielstick PC2-2V |
4 |
4474 |
Yashikawa |
/500 |
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no |
| 9. A1 |
SKL 36/24 |
4 |
1000 |
Dooason |
/200 |
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no |
| Experience at sea: Since 1998 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 19.01.2019 | |||