APPLICATION FORM
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APPLICATION FORM |
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| Name: Ivan | Surname: Bogoliy | ||||||
| Date of birth: 12.09.1977 | Place of birth: Chernigov | ||||||
| Permanent address: Chernigol, Ukraine | |||||||
| Passport (OVIR): EA 673343 | Place of issue: Chernigov | Date of issue: 07.02.2008 | Valid until: 07.02.2018 | ||||
| Seaman’s book: AB 332709 | Place of issue: Odessa | Date of issue: 04.04.2005 | Valid until: 04.04.2010 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | |||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Odessa State Maritime Academy | 3-rd Engineer | 26.02.2000 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 02114/2003/08 | Odessa |
12.06.2003 |
--- |
| Endorsement STCW | 02114/2003/08 | Odessa |
25.05.2007 |
02.04.2012 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 90584/2007 | Odessa |
03.04.2007 |
03.04.2012 |
| Advanced Fire Fighting (A-VI/3) | 45912/2007 | Odessa |
03.04.2007 |
03.04.2012 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 51120/2007 | Odessa |
02.04.2007 |
02.04.2012 |
| Medical First Aid (A-VI/4-1) | 33625/2007 | Odessa |
03.04.2007 |
03.04.2012 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. V. Solovyov | UDP | 600 | Ukraine | Tug |
3-rd Eng |
21.03.2006 |
28.04.2006 |
| 2. L. Kapikrayan | UDP | 600 | Ukraine | Tug |
3-rd Eng |
29.04.2006 |
15.08.2006 |
| 3. Anapa | UDP | 600 | Ukraine | Tug |
3-rd Eng |
22.09.2006 |
30.12.2006 |
| 4. K.Fominyikh | UDP | 600 | Ukraine | Tug |
3-rd Eng |
16.02.2007 |
20.10.2007 |
| 5. Sofia | UDP | 600 | Ukraine | Tug |
3-rd Eng |
10.02.2008 |
10.06.2008 |
| 6. Lyon | Seabird Shipping | 3916 | Georgia | Gen cargo |
2-nd Eng |
17.08.2008 |
17.12.2008 |
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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 |
SKL |
4 |
2000 |
SKL/2 |
/75 |
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| 2. A2 |
SKL |
4 |
2000 |
SKL/2 |
/75 |
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| 3. A2 |
SKL |
4 |
2000 |
SKL/2 |
/75 |
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| 4. A2 |
SKL |
4 |
2000 |
SKL/2 |
/75 |
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| 5. A2 |
SKL |
4 |
2000 |
SKL/2 |
/75 |
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| 6. A2 |
Sulzer |
4 |
4000 |
Scania |
/160 |
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| Experience at sea: Since 2006 | Knowledge Personal Computer (Yes / No): | |||
| Medical Certificate | ¹ | Issued: 20.06.2008 | Place: Izmail | Exp.date: 20.06.2009 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 2018 | |||