APPLICATION FORM
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APPLICATION FORM |
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| Name: Gennadiy | Surname: Dubovoy | ||||||
| Date of birth: 04.12.1965 | Place of birth: Alchevsk, Lugansk reg. | ||||||
| Permanent address: Alchevsk, Lugansk reg., Ukraine | |||||||
| Passport (OVIR): PO 609934 | Place of issue: Ukraine | Date of issue: 13.02.2007 | Valid until: 13.02.2017 | ||||
| Seaman’s book: AB 282619 | Place of issue: Mariupol | Date of issue: 14.10.2005 | Valid until: 14.10.2010 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Dubovaya Nataliya | ||||||
| Supported children under age of 18 | 1. Dubovaya Mariya, 18.09.2008 | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Rostov Marine College | Navigator | 14.12.1986 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00767/2003/01 | Izmail |
24.03.2003 |
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| Endorsement STCW | 00767/2003/01 | Odessa |
20.04.2007 |
12.02.2012 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 89696/2007 | Odessa |
13.02.2007 |
13.02.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00247/2003/01 | Izmail |
14.04.2003 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00247/2003/01 | Izmail |
20.04.2007 |
16.03.2012 |
| Radar Observation and Plotting (A-II/1,2) | 04436B | Odessa |
15.02.2007 |
15.02.2012 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 04436B | Odessa |
15.02.2007 |
15.02.2012 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 0071/2007 | Odessa |
16.02.2007 |
16.02.2012 |
| Advanced Fire Fighting (A-VI/3) | 0067/2007 | Odessa |
16.02.2007 |
16.02.2012 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 50470/2007 | Odessa |
16.02.2007 |
16.02.2012 |
| Ship's Medical Care (A-VI/4-2) | 0109/2007 | Odessa |
16.02.2007 |
16.02.2012 |
| Bridge Team Management | 0158/07 | Mumbai |
09.06.2007 |
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| Training for ISM code | 0404/07 | Mumbai |
08.06.2007 |
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| ECDIS Familiarization course | 0061/07 | Mumbai |
14.06.2007 |
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| Marpol Implementation | OD/146 | Odessa |
25.11.2009 |
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| Port State Control | OD/142 | Odessa |
27.11.2009 |
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| Panama Certificate of Competency | CTB 121443 | Panama |
19.03.2009 |
12.02.2012 |
| Panama G.M.D.S.S Endorsement | CTB 121444 | Panama |
19.03.2009 |
12.02.2012 |
| Marshall islands Seaman's book | MH 130205 | MI |
25.02.2008 |
24.02.2013 |
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Tanker Certificates: |
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 00615B | Odessa |
15.02.2007 |
15.02.2012 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 01217B | Odessa |
15.02.2007 |
15.02.2012 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Kevin | Clavius Shipping Inc |
13760 |
Panama |
Dry cargo |
2-nd Off |
24.03.2005 |
15.08.2005 |
| Arabian Star | Wolker Enterprises S.A. |
7600 |
Panama |
Ch. Tanker |
2-nd Off |
05.05.2006 |
14.12.2006 |
| Nordstraum | Ebony Shipmanagement |
4740 |
Norway |
Ch. Tanker |
2-nd Off |
23.05.2007 |
28.10.2007 |
| Eships Prelude | Anglo-Eastern Shipmanagement |
8500 |
MI |
Ch. Tanker |
2-nd Off |
22.01.2008 |
08.07.2008 |
| Fairchem Charger | Anglo-Eastern Shipmanagement |
21205 |
MI |
Ch. Tanker |
2-nd Off |
09.02.2009 |
14.08.2009 |
| Experience at sea: Since 1987 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccinationfor cholera valid until: | Vaccination for yellow fever valid until: 05.05.2016 | |||