APPLICATION FORM
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APPLICATION FORM |
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| Name: Ruslan | Surname: Bartyenyev | ||||||
| Date of birth: 20.12.1986 | Place of birth: Ukraine | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): AK 772665 | Place of issue: Ukraine | Date of issue: 27.01.2005 | Valid until: 27.01.2015 | ||||
| Seaman’s book: AB 292240 | Place of issue: Ukraine | Date of issue: 20.04.2004 | Valid until: 20.04.2009 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Maria Bartyenyeva | ||||||
| Supported children under age of 18 | Dar'ya Bartyenyeva, 01.11.2005 | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Kherson Maritime College | Navigator | . | 2006 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00479/2006/11 | Kherson |
19.07.2006 |
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| Endorsement STCW | 00479/2006/11 | Kherson |
19.07.2006 |
25.03.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 8770/06 KH | Kherson |
03.05.2006 |
03.06.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00250/2006/11 | Kherson |
19.07.2006 |
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| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00250/2006/11 | Kherson |
19.07.2006 |
25.03.2011 |
| Radar Observation and Plotting (A-II/1,2) | 0620/06 KH | Kherson |
08.05.2006 |
08.05.2011 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0620/06 KH | Kherson |
08.05.2006 |
08.05.2011 |
| Advanced Fire Fighting (A-VI/3) | 3913/06 KH | Kherson |
03.05.2006 |
03.05.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 5518/06 KH | Kherson |
03.05.2006 |
03.05.2011 |
| Medical First Aid (A-VI/4-1) | 3011/06 KH | Kherson |
03.05.2006 |
03.05.2011 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 01799/06 KH | Kherson |
01.02.2007 |
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Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Semyon Rudnev | ASC Ukrrichflot |
3100 |
Ukraine |
Dry cargo |
Deck cadet |
25.05.2004 |
29.08.2004 |
| Norrbotten | Scott Shipping |
4000 |
Isle of Man |
Cont |
OS |
15.04.2005 |
04.10.2005 |
| Haelsingland | Scott Shipping |
4423 |
Isle of Man |
Cont |
Nav. cadet |
08.09.2006 |
07.12.2006 |
| Olga | Bluebell Maritime Co. |
2924 |
St. Vincent&Grenada |
Cont |
2-nd Off |
03.02.2007 |
13.09.2007 |
| Experience at sea: Since 2004 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: 18.12.2007 | Place: Ukraine | Exp. date: 18.12.2008 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||