APPLICATION FORM
|
|
APPLICATION FORM |
|
| Name: Sergey | Surname: Gorlov | ||||||
| Date of birth: 23.04.1967 | Place of birth: URSS Kaunas | ||||||
| Permanent address: Vavilova, Krasnodar, Russia | |||||||
| Passport (OVIR): 63 2981569 | Place of issue: Krasnodar | Date of issue: 20.11.2007 | Valid until: 20.11.2012 | ||||
| Seaman’s book: MF 0197461 | Place of issue: Novoross | Date of issue: 12.01.2006 | Valid until: 12.01.2011 | ||||
| Citizenship: Russia | Expiry date of U.S. visa: 03.2010 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Gorlova Nina, 0303125648 | ||||||
| Supported children under age of 18 | 1. Farida Gorlova, 02.08.1992 | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Astrakhan Marine College | 3-rd Eng Class A | 2031603004 | 27.04.2007 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 2031603004 | Astrakhan |
27.04.2007 |
--- |
| Endorsement STCW | 2011622821 | Novoross |
09.11.2007 |
24.05.2010 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 048317 | Rostov |
07.05.2005 |
07.05.2010 |
| Advanced Fire Fighting (A-VI/3) | 057764 | Rostov |
19.03.2007 |
19.03.2012 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 028034 | Rostov |
27.05.2005 |
27.05.2010 |
| Medical First Aid (A-VI/4-1) | 061845 | Rostov |
15.03.2007 |
15.03.2012 |
|
Tanker Certificates |
|
| ||
| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 073000 | Rostov |
30.10.2007 |
30.10.2012 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) | 065817 | Rostov |
25.10.2007 |
25.10.2012 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 061088 | Rostov |
26.03.2007 |
26.03.2012 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Tim Buck | NB | 19000 | Cyprus | Gen cargo |
motorman |
21.03.2004 |
08.09.2004 |
| 2. Dutch pearle | Enka | 2100 | Cyprus | saplay |
motor-El |
08.08.2005 |
21.04.2006 |
| 3. Yagyar | Enka | 2500 | Cyprus | saplay |
motor-El |
10.07.2006 |
03.03.2007 |
| 4. Arina | Wind rose | 4000 | slovak | Gen cargo |
3-rd Eng |
24.04.2007 |
08.10.2007 |
| 5. Maregas | Benelux Overseas Inc | 7656 | Panama | LPG |
3-rd Eng |
12.2008 |
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 |
MAN |
2 |
8400 |
|
/ |
. |
. |
| 2. A1 |
Cater |
4 |
2x1050 |
|
/ |
. |
. |
| 3. A1 |
Detroit |
4 |
2x980 |
|
/ |
. |
. |
| 4. A1 |
Rols roys |
2 |
1965 |
|
/ |
. |
. |
| 5. A1 |
Mak |
4 |
5440 |
Yanmar/3 |
/558 |
. |
. |
| Experience at sea: Since 1987 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: 27.05.2007 | Place: Krasnodar | Exp.date: 27.05.2008 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 21.08.2015 | |||
Ready to work from: 08.2009