APPLICATION FORM
|
|
APPLICATION FORM |
|
| Name: Oleksandr | Surname: Gorshkov | ||||||
| Date of birth: 04.07.1972 | Place of birth: Odessa Reg. Ukraine | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AE 662860 | Place of issue: Odessa | Date of issue: 26.11.1997 | Valid until: 26.11.2007 | ||||
| Seaman’s book: AB 329381 | Place of issue: Odessa | Date of issue: 21.10.2004 | Valid until: 21.10.2009 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 03.10.2009 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Gorshkova Olga, pass # KE 035653 | ||||||
| Supported children under age of 18 | 1. son - Gorshkov Oleksandr - 12.12.1995 | ||||||
| (name, surname, date of birth) | 2. son - Gorshkov Kirill - 15.08.2006 | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa State Marine Academy | Automation Engineer | KG 010132 | 28.02.1995 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00318/2002/01 |
Izmail |
15.08.2002 |
-- |
| Endorsement STCW | 00318/2002/01 | Izmail |
15.08.2002 |
15.04.2007 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 61599 |
Odessa |
16.05.2002 |
16.05.2007 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 0214/2006 | Odessa |
01.02.2006 |
01.02.2011 |
| Advanced Fire Fighting (A-VI/3) | 25464 |
Odessa |
21.05.2002 |
21.05.2007 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 27920 |
Odessa |
15.05.2002 |
15.05.2007 |
| Medical First Aid (A-VI/4-1) | 19569 |
Odessa |
16.05.2002 |
16.05.2007 |
| Maintenance of Electrical and Electronic Engineering | 0234/2002 |
Odessa |
29.04.2002 |
29.04.2007 |
| Refresher and updating courses (II/1) | 022845 |
Odessa |
14.05.2002 |
14.05.2007 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Skvira |
Dp. Seagull |
26194 |
Liberia |
Bulker |
3-r Eng |
09.03.2000 |
28.11.2000 |
| 2. Selecta |
Dp. Seagull |
26194 |
Liberia |
Bulker |
3-rd Eng |
27.05.2001 |
04.03.2002 |
| 3. Aplanta |
Dp. Seagull |
23550 |
Liberia |
Bulker |
3-rd Eng |
13.09.2002 |
03.08.2003 |
| 4. Bulk Atlantic |
Dp. Seagull |
22112 |
Malta |
Bulker |
2-nd Eng |
09.10.2003 |
01.08.2004 |
| 5. Bulk Atlantic |
Dp. Seagull |
22112 |
Malta |
Bulker |
1-st as. Eng |
06.01.2005 |
18.10.2005 |
| 6.B.Europa |
Dp. Seagull |
22518 |
Cayman Islands |
Bulker |
1-st as. Eng |
26.03.2006 |
26.08.2006 |
|
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 |
Sulzer 76ND76 |
1550 |
12000 |
Daihatsu/ |
1000/680 |
. |
. |
| 2. A2 |
Sulzer 6RND76 |
1550 |
12000 |
Daihatsu/ |
1000/680 |
. |
. |
| 3. |
Sulzer 7RLB66 |
1250 |
13800 |
Daihatsu/ |
750/480 |
. |
. |
| 4. |
Sulzer 6ND68 |
1250 |
9900 |
Daihatsu/ |
650/400 |
. |
. |
| 5. |
Sulzer 6RND68 |
1250 |
9900 |
Daihatsu/ |
650/400 |
. |
. |
| 6. |
Sulzer 6RND76 |
1550 |
12000 |
Daihatsu/ |
650/400 |
. |
. |
| Experience at sea: Since 1995 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ 14,102 | Issued: | Place: Odessa | Exp.date: 16.03.2007 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 13.12.2014 | |||
Contract till: 09.2008