APPLICATION FORM
|
|
APPLICATION FORM |
|
| Name: Dmitry | Surname: Bazhan | ||||||
| Date of birth: | Place of birth: Stvaropol reg, Russia | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): 63 6211317 | Place of issue: Russia | Date of issue: 12.05.2008 | Valid until: 12.05.2013 | ||||
| Seaman’s book: ÌÔ 0217368 | Place of issue: Taganrog | Date of issue: 28.09.2007 | Valid until: 28.09.2012 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Elena Bazhan | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Rostov River College | Engineer | 13.03.1992 | |||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 2031201376 | Astrakhan |
03.06.2003 |
--- |
| Endorsement STCW | 0003/2008 | Kiev |
02.04.2008 |
10.02.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 071290 | Rostov-on-Don |
10.02.2006 |
10.02.2011 |
| Advanced Fire Fighting (A-VI/3) | 058445 | Rostov-on-Don |
16.02.2008 |
16.02.2013 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 127743 | Rostov-on-Don |
13.02.2008 |
13.02.2013 |
| Medical First Aid (A-VI/4-1) | 062541 | Rostov-on-Don |
29.02.2008 |
29.02.2013 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Dapapris 1 | Capital Shipping Co | 3160 | Ukraine | Bulker |
Ch. Eng |
06.03.2004 |
20.06.2005 |
| 2. Danapris 2 | Capital Shipping Co | 3163 | Ukraine | Bulker |
Ch. Eng |
09.09.2005 |
08.03.2006 |
| 3. Danapris 1 | Capital Shipping Co | 3160 | Ukraine | Bulker |
Ch. Eng |
11.03.2006 |
20.06.2007 |
| 4. Danapris 1 | Capital Shipping Co | 3160 | Ukraine | Bulker |
Ch. Eng |
15.10.2007 |
12.12.2007 |
| 5. Danapris 1 | Capital Shipping Co | 3160 | Ukraine | Bulker |
Ch. Eng |
06.03.2008 |
20.08.2008 |
| 6. Danapris 1 | Capital Shipping Co | 3160 | Ukraine | Bulker |
Ch. Eng |
05.01.2009 |
24.04.2009 |
| 7. Santa Elena | Atlantic Shipping | 3200 | Georgia | Bulker |
Ch. Eng |
06.05.2009 |
20.06.2009 |
|
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 |
SKL |
4 |
1400 |
K462 |
70/50 |
|
|
| 2. A2 |
SKL |
4 |
1400 |
K462 |
70/50 |
|
|
| 3. A2 |
SKL |
4 |
1400 |
K462 |
70/50 |
|
|
| 4. A2 |
SKL |
4 |
1400 |
K642 |
70/50 |
|
|
| 5. A2 |
SKL |
4 |
1400 |
K642 |
70/50 |
|
|
| 6. A2 |
SKL |
4 |
1400 |
K642 |
70/50 |
|
|
| 7. A2 |
SKL |
4 |
1400 |
K642 |
100/80 |
|
|
| Experience at sea: Since 1992 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ 001550 | Issued: 12.12.2009 | Place: Kherson | Exp.date: 12.12.2010 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||