APPLICATION FORM
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APPLICATION FORM |
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| Name: Yevgen | Surname: Besedin | ||||||
| Date of birth: 01.05.1960 | Place of birth: Russia | ||||||
| Permanent address: Sevastopol, Crimea, Ukraine | |||||||
| Passport (OVIR): AK 000392 | Place of issue: Sevastopol | Date of issue: 12.02.2004 | Valid until: 12.02.2014 | ||||
| Seaman’s book: AB 309141 | Place of issue: Sevastopol | Date of issue: 20.07.2005 | Valid until: 20.07.2010 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 12.02.2012 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Besedina Larisa | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Sevastopol Instrumentbuilding Institute | Electrical Engineer | 30.06.1988 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency Second-class El.Eng. | 01393/2002/10 | Sevastopol |
16.12.2002 |
19.01.2012 |
| Endorsement STCW | 01393/2002/10 | Sevastopol |
07.02.2007 |
19.01.2012 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 17431C | Sevastopol |
19.01.2007 |
20.01.2012 |
| Caryng Dengerous & Hazardous cargo (B-V/4, B-V/5) | 19194 KS |
Kyiv |
30.09.2005 |
30.09.2010 |
| Advanced Fire Fighting (A-VI/3) | 04586C | Sevastopol |
19.01.2007 |
20.01.2012 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 05765C | Sevastopol |
19.01.2007 |
20.01.2012 |
| Medical First Aid (A-VI/4-1) | 04577C | Sevastopol |
19.01.2007 |
20.01.2012 |
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Tanker Certificates |
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p. 16-21) | 0531C | Sevastopol |
19.01.2007 |
20.01.2012 |
| LPG carrier (Advanced and Familiarization, A-V/1, p. 23-34) | 1240C | Sevastopol |
19.01.2007 |
20.01.2012 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 01666C | Sevastopol |
19.01.2007 |
20.01.2012 |
| Cargo equipment on Tankers (A-V/1, paragraph 1) | 072/07 | Sevastopol |
19.01.2007 |
20.01.2012 |
| Crude oil washing | 00389C | Sevastopol |
19.01.2007 |
20.01.2012 |
| Inert gas system | 070/07 | Sevastopol |
19.01.2007 |
20.01.2012 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Rizskiy Zaliv |
Laskaridis Shipping |
11816 |
Panama |
Reef |
El.Eng |
07.2004 |
03.2005 |
| 2. Black Rose |
Pacmar Shipping |
37600 |
Mongolia |
Bulker |
El.Eng |
10.2005 |
09.2006 |
| 3. Elise D |
DND Management |
42000 |
Marshal Isl |
Bulker |
El.Eng |
03.2007 |
08.2007 |
| 4. EEC America |
BNAVI |
37600 |
Panama |
Bulker |
El.Eng |
02.04.2008 |
16.10.2008 |
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Main Eng. Maker/Model |
Main Engine Total HP |
Aux. Engine Maker/Number |
Aux. Engine H.P. / KW |
Voltage (220/380/440) |
Automation (A1/A2) |
Automation Systems Maker |
Crane/Maker/ |
Derrick/Maker/ |
| 1. Pielstick |
11160 |
B&W 2 |
2x1500/2x660 |
220/380 |
A2 |
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2. Sulzer |
11400 |
Daihatsu |
3x480 |
110/440 |
A2 |
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IHI/4/15 |
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3. B&W |
10800 |
Mitsui 3 |
3x440 |
110/440 |
A1 |
Mitsui |
Mitsui/4/25 |
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4. IHI Sulzer |
11400 |
Daihatsu |
3x460 |
440 |
A2 |
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IHI/2x25/2x15 |
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| Experience at sea: Since 1988 | Knowledge Personal Computer (Yes / No): | |||
| Medical Certificate | ¹ | Issued: 07.02.2007 | Place: | Exp.date: 07.02.2008 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 10.2011 | |||