APPLICATION FORM
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APPLICATION FORM |
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| Name: Andriy | Surname: Babushev | ||||||
| Date of birth: 18.10.1974 | Place of birth: Kherson | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): EE 870291 | Place of issue: Kherson | Date of issue: 16.01.2009 | Valid until: 01.2019 | ||||
| Seaman’s book: AB 307486 | Place of issue: Kherson | Date of issue: 30.08.2006 | Valid until: 08.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 03.2014 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Babusheva Viktoriya | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kherson Maritime College | Navigator | 06.1997 | |||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00714/2006/11 | Kherson |
22.09.2006 |
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| Endorsement STCW | 00714/2006/11 | Kherson |
22.09.2006 |
28.07.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 11959 | Kherson |
28.07.2006 |
28.07.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00347/2006/11 | Kherson |
28.07.2006 |
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| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00347/2006/11 | Kherson |
28.07.2006 |
28.07.2011 |
| Radar Observation and Plotting (A-II/1,2) | 0595 | Kherson |
28.07.2006 |
28.07.2011 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0595 | Kherson |
28.07.2006 |
28.07.2011 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 02206 | Kherson |
28.07.2006 |
28.07.2011 |
| Advanced Fire Fighting (A-VI/3) | 05107 | Kherson |
28.07.2006 |
28.07.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 8630/06250 | Kherson |
28.07.2006 |
28.07.2011 |
| Medical First Aid (A-VI/4-1) | 02603 | Kherson |
28.07.2006 |
28.07.2011 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 000218/2009/08 | Nikolaev |
13.03.2009 |
13.03.2014 |
| Antigua certificate of competency | 75846 | Rotterdam |
17.01.2008 |
17.01.2013 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Tanais | Mermaid Marine |
5665 |
Belize |
Gen cargo |
2-nd Off |
18.10.2006 |
23.03.2007 |
| Malagasy | Sodimar S.A. |
10082 |
St.Vincent |
Multipurp |
2-nd Off |
10.05.2007 |
25.10.2007 |
| Tina | Baum Co |
7671 |
Ant&Barb |
Multipurp/Cont |
2-nd Off |
14.01.2008 |
13.05.2008 |
| BBC Mexico | W.Bockstiegel |
7500 |
Ant&Barb |
Multipurp/Heavy lift |
2-nd Off |
24.08.2008 |
25.12.2008 |
| BBC Zarate | W.Bockstiegel |
13740 |
Ant&Barb |
Multipurp/Heavy lift |
2-nd Off |
31.03.2009 |
14.08.2009 |
| Experience at sea: Since 1998 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: 25.11.2009 | Place: Kherson | Exp. date: 25.11.2010 |
| Vaccinationfor cholera valid until: | Vaccination for yellow fever valid until: 10.09.2016 | |||