APPLICATION FORM
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APPLICATION FORM |
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| Name: Andrey | Surname: Alexeev | ||||||
| Date of birth: 17.03.1962 | Place of birth: Abkhazskaya ASSR | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): 62 9312908 | Place of issue: Murmansk | Date of issue: 28.05.2007 | Valid until: 28.05.2012 | ||||
| Seaman’s book: AB 402820 | Place of issue: Odessa | Date of issue: 10.06.2009 | Valid until: 10.06.2014 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Larisa Starikova | ||||||
| Supported children under age of 18 | 1. Timofey Kruglik, 26.11.1998 | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa High Engineer Marine School | Sea Routs Navigator | . | 27.03.1985 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 1030101433 | Murmansk |
04.04.2002 |
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| Endorsement STCW | 1030101433 | Murmansk |
04.04.2002 |
10.12.2010 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 068014 | St.Petersburg |
16.12.2005 |
16.12.2010 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 0033592 | Murmansk |
18.03.2002 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 0033592 | Murmansk |
18.03.2002 |
27.01.2011 |
| Radar Observation and Plotting (A-II/1,2) | 0074370 | St.Petersburg |
23.06.2006 |
23.06.2011 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0074370 | St.Petersburg |
23.06.2006 |
23.06.2011 |
| Advanced Fire Fighting (A-VI/3) | 030816 | St.Petersburg |
23.12.2005 |
23.12.2010 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats | 054162 | St.Petersburg |
23.12.2005 |
23.12.2010 |
| Medical First Aid (A-VI/4-1) | 034801 | St.Petersburg |
10.12.2005 |
10.12.2010 |
| Ship's Medical Care (A-VI/4-2) | 034801 | St.Petersburg |
10.12.2005 |
10.12.2010 |
| St.Vincent & Grenadines Endorsement | d/g07011657583/CH | St.Vincent |
16.01.2007 |
10.12.2010 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Tuloma | Koma Shipping |
29662 |
St.Vincent |
Bulk carrier |
Master |
25.05.2004 |
23.08.2004 |
| Tuloma | Koma Shipping |
29662 |
St.Vincent |
Bulk carrier |
Master |
26.10.2004 |
18.03.2005 |
| Tuloma | Koma Shipping |
29662 |
St.Vincent |
Bulk carrier |
Master |
21.06.2005 |
23.09.2005 |
| Tuloma | Koma Shipping |
29662 |
St.Vincent |
Bulk carrier |
Master |
04.02.2006 |
06.06.2006 |
| Tuloma | Koma Shipping |
29662 |
St.Vincent |
Bulk carrier |
Master |
11.10.2006 |
22.03.2007 |
| Tuloma | Koma Shipping |
29662 |
St.Vincent |
Bulk carrier |
Master |
05.09.2007 |
16.01.2008 |
| Tuloma | Koma Shipping |
29662 |
St.Vincent |
Bulk carrier |
Master |
21.05.2008 |
24.10.2008 |
| Experience at sea: Since 1985 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 27.01.2011 | |||