APPLICATION FORM
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APPLICATION FORM |
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| Name: Sergey | Surname: Perepechaev | ||||||
| Date of birth: 02.03.1964 | Place of birth: Russia | ||||||
| Permanent address: Kaliningrad, Russia | |||||||
| Passport (OVIR): 70 2466377 | Place of issue: Russia | Date of issue: 18.03.2009 | Valid until: 18.03.2014 | ||||
| Seaman’s book: ÌÔ 0167965 | Place of issue: Russia | Date of issue: 27.04.2002 | Valid until: 19.04.2012 | ||||
| Citizenship: Russia | Expiry date of U.S. visa: 19.08.2011 | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | brother - Yuriy Perepechaev | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Riga State Marine Academy | Engineer | 1989 | |||||
| Rostov on Don Marine College | Engineer | 2004 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 1011301966 | St.Petersburg |
05.06.2008 |
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| Endorsement STCW | 1011320599 | St.Petersubrg |
10.06.2009 |
04.05.2013 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 162843 | St.Petersburg |
04.05.2008 |
04.05.2013 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 229/2004 | Kaliningrad |
21.04.2004 |
24.03.2011 |
| Advanced Fire Fighting (A-VI/3) | 083978 | St.Petersburg |
08.05.2008 |
08.05.2013 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 153513 | St.Petersburg |
06.05.2008 |
06.05.2013 |
| Medical First Aid (A-VI/4-1) | 086838 | St.Petersburg |
14.05.2008 |
14.05.2013 |
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Tanker Certificates |
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 073164 | Rostov-on-Don |
28.02.2009 |
28.02.2014 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 073164 | Rostov-on-Don |
28.02.2009 |
28.02.2014 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Kasuga Bay | Ross Reefer | 10641 | Panama | Reefer |
mman/electr |
24.12.2005 |
20.05.2006 |
| 2. Iballa G | Penn Lilac Trading S | 7154 | Panama | Ch./Oil Tank |
4-th Eng |
08.06.2006 |
25.08.2006 |
| 3. Green Guatemala | Green Management | 7726 | Bahamas | Reefer |
3-rd Eng |
23.05.2007 |
04.08.2007 |
| 4. Hyundai Highwiy | Danaos Shipping | 24757 | Panama | Container |
3-rd Eng |
31.03.2008 |
05.05.2008 |
| 5. Carola | Intersee | 8600 | Antigua | Dry cargo |
2-nd Eng |
05.07.2008 |
08.02.2009 |
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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. A1 |
B&W 6L67GB |
2 |
12000 |
Yanmar |
700/515 |
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| 2. A1 |
2xFiat Cy16 |
4 |
5000 |
Caterpillar |
500/368 |
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| 3. A1 |
Man B&W 7S |
2 |
8110 |
Man B&W |
650/478 |
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| 4. A1 |
Man B&W 7S |
2 |
26740 |
Man B&W |
1100/809 |
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| 5. A1 |
Mak 32 |
4 |
4320 |
Scania |
500/368 |
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| Experience at sea: Since 2001 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: 01.03.2010 | Place: Novorossiysk | Exp.date: 01.03.2011 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 25.12.2012 | |||