APPLICATION FORM

 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

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency  00503/2009/06  Mariupol

16.11.2009

---

 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):

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

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

 1.

 

 

 

 

 

 

 

 

 

 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: