APPLICATION FORM
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APPLICATION FORM |
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| Name: Vladimir | Surname: Dovzhenko | ||||||
| Date of birth: 26.10.1952 | Place of birth: USSR | ||||||
| Permanent address: Murmansk, Russia | |||||||
| Passport (OVIR): 51 2602259 | Place of issue: Russia | Date of issue: 30.12.2004 | Valid until: 30.12.2009 | ||||
| Seaman’s book: ÌÔ 0085698 | Place of issue: Russia | Date of issue: 27.04.2004 | Valid until: 27.04.2009 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | . | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Murmansk Marine Academy | Navigator | . | 05.1993 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 1010101424 | St.Petersburg |
25.01.2002 |
19.01.2012 |
| Endorsement STCW | 1010101424 | St.Petersburg |
25.01.2002 |
19.01.2012 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 116066 | St.Petersburg |
16.02.2007 |
16.02.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 0033389 | St.Petersburg |
17.12.2001 |
19.01.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 0033389 | St.Petersburg |
17.12.2001 |
19.01.2012 |
| Radar Observation and Plotting (A-II/1,2) | 0079172 | Murmansk |
13.01.2007 |
13.01.2012 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0079172 | Murmansk |
13.01.2007 |
13.01.2012 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 42/2002 | St.Petersburg |
24.05.2002 |
--- |
| Advanced Fire Fighting (A-VI/3) | 056614 | St.Petersburg |
20.02.2007 |
20.02.2012 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 095684 | St.Petersburg |
22.02.2007 |
22.02.2012 |
| Medical First Aid (A-VI/4-1) | 033417 | Murmansk |
31.01.2007 |
31.01.2012 |
| Ship's Medical Care (A-VI/4-2) | 033417 | Murmansk |
31.01.2007 |
31.01.2012 |
| Bridge Team Management | 132/2007 | St.Petersburg |
12.10.2007 |
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| ECDIS | 0101955 | St.Petersburg |
19.10.2007 |
19.10.2012 |
| Master endorsement (Gibraltar) | 0006705 | Gibraltar |
24.10.2007 |
19.01.2012 |
| Master endorsement (Cyprus) | RE00547606 | Cyprus |
03.09.2007 |
19.01.2012 |
| Seamen book (Cyprus) | CY113046 | Cyprus |
03.09.2007 |
02.09.2017 |
| Ship Security Officer (Liberia) | 011672 | St.Petersburg |
22.04.2005 |
22.04.2010 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | SSO2459/05 | St.Petersburg |
22.04.2005 |
22.04.2010 |
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Tanker Certificates: |
. |
. |
. |
. |
| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 005840 | Russia |
16.01.2004 |
--- |
| Specialized liquefied gas tanker training (A-V/1, p.23-34) | 056230 | Russia |
02.03.2007 |
02.03.2012 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 011379 | Russia |
14.03.2003 |
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| Specialized chem. tanker training (A-V/1, p.16-21) | 056082 | Russia |
02.03.2007 |
02.03.2012 |
| Specialized oil tanker training (A-V/1, p. 9-14) | 062738 | Russia |
02.03.2007 |
02.03.2012 |
| Oil tanker endorsement (management) | 1010121664 | St.Petersburg |
09.03.2007 |
19.01.2012 |
| Liquid chemicals endorsement (management) | 1010121664 | St.Petersburg |
09.03.2007 |
19.01.2012 |
| Gas endorsement (Operational) | 1010121665 | St.Petersburg |
09.03.2007 |
19.01.2012 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Islandview | Tisland Capital Co. |
3368 |
Gibraltar |
Ch. tanker |
Master |
12.05.2004 |
15.07.2004 |
| Severomorsk | Dukkar Engineering Ltd |
39750 |
Russia |
Oil tanker |
Master |
16.08.2004 |
31.12.2004 |
| Polartank | Polyus-nord Ltd |
1774 |
Russia |
Oil Ch. tanker |
Master |
05.02.2005 |
15.03.2006 |
| Marvel | Lassi Shipping Co. Ltd |
3921 |
Panama |
Prod. tanker |
Master |
16.06.2006 |
25.12.2006 |
| Bonnie | EDT Offshore Ltd |
2654 |
Cyprus |
Oil tanker |
Master |
14.07.2007 |
12.09.2007 |
| Natasja Theresa | Hanseatic Shipping Co. |
4318 |
Gibraltar |
Oil Ch. tanker |
Master |
21.10.2007 |
25.12.2007 |
| Biskra | Maritec N.V. |
11404 |
Pamama |
Oil tanker |
Master |
15.05.2008 |
31.07.2008 |
| Prof. Viktor Vologdin | Nadezhda Shipmanag Ltd |
5756 |
Malta |
Gen cargo |
Master |
18.08.2008 |
31.08.2008 |
| Brovig Vindur | Brovigtank A/S |
4653 |
Gibraltar |
Oil Ch. tanker |
Master |
08.04.2009 |
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| Experience at sea: Since 1974 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 10.07.2010 | |||