APPLICATION FORM
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APPLICATION FORM |
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| Name: Aleksandr | Surname: Gudzenko | ||||||
| Date of birth: 09.05.1977 | Place of birth: Odessa, Ukraine | ||||||
| Permanent address: 6 Pilotnaya Str., Odessa, Ukraine | |||||||
| Passport (OVIR): AM 659772 | Place of issue: Odessa | Date of issue: 12.07.2000 | Valid until: 12.07.2010 | ||||
| Seaman’s book: AB 359415 | Place of issue: Nikolaev | Date of issue: 31.12.2008 | Valid until: 23.12.2013 | ||||
| Citizenship: Ukrainian | Expiry date of U.S. visa: | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Gudzenko Svetlana pas. KK 508484 | ||||||
| Supported children under age of 18 | - | ||||||
| (name, surname, date of birth) | - | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa Technical Marine School | Motorman/AB | 39 | 03.01.1998 | ||||
| Odessa National Maritime Academy | Navigator/Energy of the Ships | CK 2539263 | 30.06.2004 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00021/2009/07 | Nikolaev |
14.01.2009 |
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| Endorsement STCW | 00021/2009/07 | Nikolaev |
14.01.2009 |
26.11.2013 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 08403/2008/42/01 | Nikolaev |
26.11.2008 |
26.11.2013 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00767/2004/08 | Odessa |
16.07.2004 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00767/2004/08 | Nikolaev |
13.01.2009 |
12.01.2014 |
| Radar Observation and Plotting (A-II/1,2) | 01049/2008/42/31 | Nikolaev |
26.11.2008 |
26.11.2013 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 01049/2008/42/31 | Nikolaev |
26.11.2008 |
26.11.2013 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 04576/2008/42/20 | Nikolaev |
26.11.2008 |
26.11.2013 |
| Advanced Fire Fighting (A-VI/3) | 03839/2008/42/04 | Nikolaev |
26.11.2008 |
26.11.2013 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 06814/2008/42/02 | Nikolaev |
26.11.2008 |
26.11.2013 |
| Ship's Medical Care (A-VI/4-2) | 01088/2008/42/06 | Nikolaev |
26.11.2008 |
26.11.2013 |
| Ro-Ro Passenger ships (A-V/2) | 00295/2008/42/08 | Nikolaev |
26.11.2008 |
26.11.2013 |
| Passenger ships other than Ro-Ro (A-V/3) | 00369/2008/42/09 | Nikolaev |
26.11.2008 |
26.11.2013 |
| Ship Handling Arrangements (A-II/2) | 01112/2008/42/60 | Nikolaev |
26.11.2008 |
26.11.2013 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 0524/2005 | Odessa |
22.04.2005 |
22.04.2010 |
| Panama Seaman's book | 199224 | Londres |
06.10.2004 |
06.10.2009 |
| Cyprus Seaman's book | CY 080097 | Lemesos |
18.05.2005 |
17.05.2015 |
| Liberia Seaman's book | 0738236 | USA |
18.04.2006 |
18.04.2011 |
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Tanker Certificates |
. | . |
. |
. |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 00643/2008/42/11 | Nikolaev |
26.11.2008 |
26.11.2013 |
| Cargo equipment on Tankers (A-V/1, p.1) | 01475/2008/42/10 | Nikolaev |
26.11.2008 |
26.11.2013 |
| Crude oil washing | 00184/2008/42/15 | Nikolaev |
26.11.2008 |
26.11.2013 |
| Inert gas system | 00130/2008/42/16 | Nikolaev |
26.11.2008 |
26.11.2013 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Costa-S | Alkionis-2 Shipping |
3699 |
Panama |
Bulk carrier |
OS/3-rd Off |
01.10.2004 |
01.04.2005 |
| Kiti | Kiti Maritime Co Ltd |
35064 |
Cyprus |
Bulk carrier |
AB/3-rd Off |
02.07.2005 |
03.12.2005 |
| Green Mountain | Zodiac Maritime Agencies Ltd |
8489 |
Liberia |
Reefer |
3-rd Off |
02.04.2006 |
21.02.2007 |
| Pioneer Bay | Ebony Shipmanagement Pvt Ltd |
8676 |
Liberia |
Reefer |
3-rd Off |
28.05.2007 |
01.12.2007 |
| Captain Corelli | Wallem Shipmanagement Ltd |
28379 |
Hang Kong |
Bulk carrier |
3-rd Off |
10.01.2008 |
03.04.2008 |
| Captain Corelli | Wallem Shipmanagement Ltd |
28379 |
Hang Kong |
Bulk carrier |
2-nd Off |
03.04.2008 |
28.09.2008 |
| Experience at sea: Since 2001 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 00691 | Issued: 26.11.2008 | Place: Odessa | Exp. date: 26.11.2009 |
| Vaccination for cholera valid until: 2009 | Vaccination for yellow fever valid until: January 2011 | |||