APPLICATION FORM
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APPLICATION FORM |
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| Name: Oleg | Surname: Dolgov | ||||||
| Date of birth: 21.06.1970 | Place of birth: Kherson | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): AT 894111 | Place of issue: Kherson | Date of issue: 09.09.2002 | Valid until: 09.09.2012 | ||||
| Seaman’s book: AB 295236 | Place of issue: Kherson | Date of issue: 14.05.2004 | Valid until: 28.04.2014 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 24.01.2012 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Dolgova Elena | ||||||
| Supported children under age of 18 | Dolgova Alla - 12.02.1994 | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kherson Marine College | Navigator | 03.07.1997 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00376/2002/01 | Izmail |
21.08.2002 |
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| Endorsement STCW | 00376/2002/01 | Nikolaev |
18.11.2009 |
14.10.2014 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 12109/2009/42 | Nikolaev |
14.10.2009 |
14.10.2014 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00032/2005/11 | Kherson |
05.04.2005 |
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| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00032/2005/11 | Nikolaev |
18.11.2009 |
14.10.2014 |
| Radar Observation and Plotting (A-II/1,2) | 01567/2009/42 | Nikolaev |
14.10.2009 |
14.10.2014 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 01567/2009/42 | Nikolaev |
14.10.2009 |
14.10.2014 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 07550/2009/42 | Nikolaev |
14.10.2009 |
14.10.2014 |
| Advanced Fire Fighting (A-VI/3) | 05501/2009/42 | Nikolaev |
14.10.2009 |
14.10.2014 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 10131/2009/42 | Nikolaev |
14.10.2009 |
14.10.2014 |
| Ship's Medical Care (A-VI/4-2) | 01589/2009/42 | Nikolaev |
14.10.2009 |
14.10.2014 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Nats Emperor | Pitousa Shipping |
36964 |
Cyprus |
Bulk carrier |
Ch. Off |
08.06.2005 |
18.03.2006 |
| Morning Cloud | Zodiac Agency |
68754 |
Liberia |
Bulk carrier |
Ch. Off |
11.02.2007 |
05.10.2007 |
| Omegas | BSM |
73606 |
Liberia |
Bulk carrier |
Ch. Off |
27.12.2007 |
30.05.2008 |
| Star Gamma | BSM |
53098 |
MI |
Bulk carrier |
Ch. Off |
14.09.2008 |
14.01.2009 |
| Medi Tokyo | D'Amico Shipping |
74356 |
Italy |
Bulk carrier |
Ch. Off |
11.05.2009 |
15.09.2009 |
| Experience at sea: Since 1992 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccinationfor cholera valid until: | Vaccination for yellow fever valid until: 13.02.2011 | |||