APPLICATION FORM
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APPLICATION FORM |
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| Name: Vladimir | Surname: Khudyakov | ||||||
| Date of birth: 22.05.1947 | Place of birth: Russia | ||||||
| Permanent address: Kerch, Ukraine | |||||||
| Passport (OVIR): AE 524224 | Place of issue: Kerch | Date of issue: 05.10.1999 | Valid until: 05.10.2009 | ||||
| Seaman’s book: AB 325221 | Place of issue: Kerch | Date of issue: 14.11.2006 | Valid until: 14.11.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | . | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Sevastopol Instrumentation Institute | 2-nd Eng | . | 1975 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00069/2007/05 | Kerch |
29.11.2007 |
--- |
| Endorsement STCW | 00069/2007/05 | Kerch |
29.11.2007 |
29.11.2012 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 07123C | Sevastopol |
09.11.2007 |
09.11.2012 |
| Advanced Fire Fighting (A-VI/3) | 03163C | Sevastopol |
09.11.2007 |
09.11.2012 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 04720C | Sevastopol |
09.11.2007 |
09.11.2012 |
| Medical First Aid (A-VI/4-1) | 02017C | Sevastopol |
09.11.2007 |
09.11.2012 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Anadyr | Omar Ltd | 2500 | Russia | Reefer |
2-nd Eng |
01.03.2004 |
01.09.2004 |
| 2. Alexa | Neptun | 5000 | Russia | Reefer |
2-nd Eng |
01.09.2005 |
01.02.2006 |
| 3. Gevo Victory | Gezairi | 3690 | Lebanon | Gen cargo |
2-nd Eng |
22.11.2006 |
15.06.2007 |
| 4. Partner | White Hose Maritime | 2551 | Belize | Gen cargo |
2-nd Eng |
16.06.2006 |
21.12.2007 |
| 5. Anya | Pacific Naval Ltd | 4371 | St.Kitts&Nevis | Gen cargo |
2-nd Eng |
24.01.2008 |
25.08.2008 |
|
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 |
3D100 |
4 |
4x1240 |
Skoda |
/300 |
. |
. |
| 2. A2 |
2xNVD48AU |
4 |
2x1000 |
6×18/22 |
/220 |
. |
. |
| 3. A2 |
Sulzer |
4 |
1800 |
Skoda |
/200 |
. |
. |
| 4. A2 |
Deutz |
4 |
3000 |
Sulzer |
/180 |
. |
. |
| 5. A2 |
Yanmar |
4 |
2x2360 |
B&W |
/200 |
. |
. |
| Experience at sea: Since 1975 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 20.08.2012 | |||
Ready to work from: any time