APPLICATION FORM
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APPLICATION FORM |
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| Name: Denys | Surname: Kaganovych | ||||||
| Date of birth: 28.06.1977 | Place of birth: Sevastopol | ||||||
| Permanent address: Sevastopol, Ukraine | |||||||
| Passport (OVIR): EK 752174 | Place of issue: Sevastopol | Date of issue: 29.01.2010 | Valid until: 29.01.2020 | ||||
| Seaman’s book: AB 390702 | Place of issue: Sevastopol | Date of issue: 29.08.2004 | Valid until: 18.08.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Kaganovych Larisa | ||||||
| Supported children under age of 18 | son - Kaganovych Andriy | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kerch Marine Tech. Institute | Navigator | 25.02.2000 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00445/2007/10 | Sevastopol |
13.08.2007 |
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| Endorsement STCW | 00445/2007/10 | Sevastopol |
13.08.2007 |
19.07.2012 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 09394 SV | Sevastopol |
19.07.2007 |
19.07.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00005/2003/10 | Sevastopol |
17.01.2003 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00005/2003/10 | Sevastopol |
14.08.2007 |
19.07.2012 |
| Radar Observation and Plotting (A-II/1,2) | 04281/2007/25/31 | Sevastopol |
20.07.2007 |
20.07.2012 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 04281/2007/25/31 | Sevastopol |
20.07.2007 |
20.07.2012 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 02598 SV | Sevastopol |
19.07.2007 |
19.07.2012 |
| Advanced Fire Fighting (A-VI/3) | 03713 SV | Sevastopol |
19.07.2007 |
19.07.2012 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 05687 SV | Sevastopol |
19.07.2007 |
19.07.2012 |
| Ship's Medical Care (A-VI/4-2) | 0792 SV | Sevastopol |
19.07.2007 |
19.07.2012 |
| Ship Handling | 00528/2007/44/60 | Sevastopol |
20.07.2007 |
20.07.2012 |
| Panama G.M.D.S.S. General Operator | 36 420407 | Panama |
19.04.2008 |
19.07.2012 |
| Panama Master | 11G0409999 | Panama |
13.04.2008 |
13.07.2012 |
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Tanker Certificates: |
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|
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 0407 SV | Sevastopol |
19.07.2007 |
19.07.2012 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) | 0019 SV | Sevastopol |
19.07.2007 |
19.07.2012 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 01756 SV | Sevastopol |
19.07.2007 |
19.07.2012 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Nagoya Bay | Roswell Navigation Co |
9755 |
Panama |
Reefer |
Ch. Off |
10.05.2005 |
25.10.2005 |
| Kasuga Bay | Roswell Navigation Co |
9274 |
Panama |
Reefer |
Ch. Off |
12.02.2006 |
30.09.2006 |
| Silver Cape | Fjord Shipping AS |
6420 |
Norway |
Reefer |
Ch. Off |
11.12.2006 |
18.06.2007 |
| Framnes | Fjord Shipping AS |
1640 |
Norway |
Reefer |
Ch. Off |
04.10.2007 |
22.01.2008 |
| Silver Fjord | Fjord Shipping Co |
1770 |
Panama |
Reefer/Ro-Ro |
Ch. Off |
05.03.2008 |
05.07.2008 |
| Silver Fjord | Fjord Shipping Co |
1770 |
Panama |
Reefer/Ro-Ro |
Ch. Off |
22.11.2008 |
30.01.2009 |
| Silver Fjord | Fjord Shipping Co |
1770 |
Panama |
Reefer/Ro-Ro |
Master |
30.01.2009 |
15.05.2009 |
| Silver Fjord | Fjord Shipping Co |
1770 |
Panama |
Reefer/Ro-Ro |
Master |
09.09.2009 |
09.12.2009 |
| Silver Fjord | Fjord Shipping Co |
1770 |
Panama |
Reefer/Ro-Ro |
Master |
03.03.2010 |
03.06.2010 |
| Experience at sea: Since 2004 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 4055 | Issued: 01.03.2010 | Place: Sevastopol | Exp. date: 01.03.2011 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 03.03.2016 | |||