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APPLICATION FORM |
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| Name: Oleksandr | Surname: Shubniakov | ||||||
| Date of birth: 16.02.1982 | Place of birth: Russia | ||||||
| Permanent address: Mariupol, Ukraine | |||||||
| Passport (OVIR): EK 077803 | Place of issue: Mariupol | Date of issue: 27.03.2009 | Valid until: 27.03.2019 | ||||
| Seaman’s book: AB 423632 | Place of issue: Mariupol | Date of issue: 11.09.2009 | Valid until: 11.09.2014 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | mother - Shubniakova Tetiana | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Pryazov State Technical University | El. Engineer | 15.07.2004 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00503/2009/06 | Mariupol |
16.11.2009 |
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| Endorsement STCW | 00503/2009/06 | Mariupol |
16.11.2009 |
04.08.2014 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 208451-AS | Mariupol |
04.08.2009 |
04.08.2014 |
Sea service (during five last years):
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N |
Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. | Alamak | Mariupol port |
57 |
Ukraine |
Tug |
Cadet |
26.06.2009 |
26.08.2009 |
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N |
Main Eng. Maker/Model |
Engine Total HP |
Aux.Engine Maker/Number,s |
Aux. Engine H.P. / KW |
Voltage (220/380/440) |
Automation class (A1/A2) |
Automation System Maker |
Crane/Maker/ Type/SWL |
Derrick/Maker/ Type/SWL |
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1. |
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| Experience at sea: Since 2009 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||