APPLICATION FORM
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APPLICATION FORM |
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| Name: Anatoliy | Surname: Baulin | ||||||
| Date of birth: 1951 | Place of birth: Feodosia | ||||||
| Permanent address: Feodosia, Ukraine | |||||||
| Passport (OVIR): EA 996227 | Place of issue: Feodosia | Date of issue: 13.05.2008 | Valid until: 13.05.2018 | ||||
| Seaman’s book: AB 315767 | Place of issue: Kerch | Date of issue: 03.07.2007 | Valid until: 03.07.2012 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Baulina Tatyana, EC 354415 | ||||||
| Supported children under age of 18 | Baulina Oksana, 1980 | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Poor | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kherson secondary marine school | Tech. Engineer | 1990 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00877/2003/10 | Sevastopol |
29.07.2003 |
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| Endorsement STCW | 00877/2003/10 | Kerch |
21.04.2006 |
09.09.2010 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 61598/MPS | Kherson |
21.04.2006 |
09.09.2010 |
| Advanced Fire Fighting (A-VI/3) | 37544/MPS | Kherson |
09.09.2005 |
09.09.2010 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 85723/MPS | Kherson |
09.09.2005 |
09.09.2010 |
| Medical First Aid (A-VI/4-1) | 33226/MPS | Kherson |
09.09.2005 |
09.09.2010 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Chalsi | Kondor | 5050 | Malta | Gen cargo |
Ch. Eng |
06.2004 |
12.2004 |
| 2. Goodwish | Marine star | 5000 | Panama | Gen cargo |
Ch. Eng |
03.2005 |
08.2005 |
| 3. Alex - D | Marine pro service | 1500 | N. Antilles | Gen cargo |
Ch. Eng |
09.2005 |
04.2006 |
| 4. Gregorio I | Marine pro service | 6000 | Cyprus | Gen cargo |
Ch. Eng |
05.2006 |
11.2006 |
| 5. Alma | Marine star | 4000 | Barbuda | Gen cargo |
Ch. Eng |
01.2007 |
05.2007 |
| 6. Green Fast | Myklebusthang | 8000 | Panama | Container |
Ch. Eng |
08.2007 |
09.2007 |
| 7. Agat | Marine Star | 4000 | Ant&Barb | Gen cargo |
Ch. Eng |
10.2007 |
11.2007 |
| 8. ACS Demonstrator | Phoenix Reederei | 4000 | Ant&Barb | Univers cargo |
Ch. Eng |
12.2007 |
04.2008 |
| 9. Tuxtan Reef | Phoenix Reederei | 5000 | Ant&Barb | Univers cargo |
Ch. Eng |
07.2008 |
10.2008 |
| 10. BBC Thailand | Lubeca | 8500 | Ant&Barb | Univers cargo |
Ch. Eng |
11.2008 |
02.2009 |
| 11. Zamil 53 | Zamil Offshore | 1546 | Bahrain | AHTS |
Ch. Eng |
07.2009 |
10.2009 |
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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. A1 |
Alfa Diezel B&W |
|
2000 |
Deutz |
/50 |
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| 2. A2 |
B&W |
|
11500 |
Yanmar |
/400 |
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| 3. A2 |
Sulzer |
|
10500 |
Yanmar |
/400 |
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| 4. A1 |
G 70 |
|
2200 |
SKL |
/250 |
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| 5. A1 |
Merlis |
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3500 |
Merlis |
/300 |
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| 6. A1 |
Caterpillar |
|
1000 |
DAF |
/250 |
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| 7. A2 |
B&W |
|
3500 |
Yanmar |
/300 |
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| 8. A1 |
Deutz |
|
1500 |
Deutz |
/360 |
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| 9. A1 |
MAK |
|
3100 |
MAK |
/300 |
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| 10. A1 |
MAK |
|
2970 |
Commussion |
/3x350 |
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| 11. A1 |
MAK |
|
2970 |
Commussion |
/3x350 |
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| Experience at sea: Since 1973 | Knowledge Personal Computer (Yes / No): | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||