APPLICATION FORM
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APPLICATION FORM |
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| Name: Evgeny | Surname: Kulikov | ||||||
| Date of birth: 01.04.1977 | Place of birth: Russia | ||||||
| Permanent address: Vladivostok, Russia | |||||||
| Passport (OVIR): 8255515 | Place of issue: Nakhodka | Date of issue: 22.09.2008 | Valid until: 22.09.2013 | ||||
| Seaman’s book: 0221415 | Place of issue: Vladivostok | Date of issue: 24.05.2006 | Valid until: 24.05.2011 | ||||
| Citizenship: Russia | Expiry date of U.S. visa: 20.11.2010 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Kulikova Viktoria | ||||||
| Supported children under age of 18 | 1. Kulikov Danil, 04.06.2009 | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Far East Technical Fishing University | Navigator | 07.2000 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 3010204931 | Russia |
23.04.2007 |
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| Endorsement STCW | 3010224676 | Russia |
03.05.2007 |
21.03.2012 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 077096 | Russia |
13.04.2007 |
13.04.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 0046821 | Russia |
20.07.2009 |
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| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 0046821 | Russia |
20.07.2009 |
16.07.2014 |
| Radar Observation and Plotting (A-II/1,2) | 0022797 | Russia |
01.03.2007 |
01.03.2012 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0022797 | Russia |
01.03.2007 |
01.03.2012 |
| Advanced Fire Fighting (A-VI/3) | 035068 | Russia |
13.04.2007 |
13.04.2012 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 061047 | Russia |
13.04.2007 |
13.04.2012 |
| Medical First Aid (A-VI/4-1) | 032442 | Russia |
12.03.2007 |
12.03.2012 |
| Ship's Medical Care (A-VI/4-2) | 032442 | Russia |
12.03.2007 |
12.03.2012 |
| Cyprus Seaman's book | CY 037716 | Cyprus |
08.04.2003 |
08.04.2013 |
| Panama Seaman's book | LA-09-0141-A | Panama |
03.04.2009 |
29.02.2012 |
| Panama Endorsement | 12GO407176 | Panama |
03.04.2009 |
29.02.2012 |
| Marshall islands Seaman's book | MH 97550 | USA |
21.08.2006 |
20.08.2011 |
| Malta Endorsement | 58178 | Malta |
18.06.2007 |
29.02.2012 |
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Tanker Certificates: |
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 039184 | Russia |
30.03.2007 |
30.03.2012 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 038649 | Russia |
21.03.2007 |
21.03.2012 |
| Crude oil washing | 038649 | Russia |
21.03.2007 |
21.03.2012 |
| Inert gas system | 038649 | Russia |
21.03.2007 |
21.03.2012 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Akademik Hohlov | Rimsco |
6391 |
Russia |
Refrigerator |
2-nd Off |
04.2004 |
05.2005 |
| Lukomorye | Rimsco |
5105 |
Russia |
Oil tanker |
2-nd Off |
01.2006 |
02.2006 |
| Omega Princess | Baltic Group International |
36660 |
MI |
Oil/Ch. tanker |
3-rd Off |
07.2006 |
02.2007 |
| Chem Jasmin | Baltic Group International |
29990 |
Malta |
Oil/Ch. tanker |
2-nd Off |
30.05.2007 |
18.08.2007 |
| Chem Jasmin | Baltic Group International |
29990 |
Malta |
Oil/Ch. tanker |
Ch. Off |
19.08.2007 |
09.11.2007 |
| Breeze A | Baltic Group International |
32396 |
Malta |
Oil/Ch. tanker |
Ch. Off |
11.03.2008 |
31.07.2008 |
| Golden Nori | Maritime Agency Primtanko Ltd |
12036 |
Panama |
Ch. tanker |
Ch. Off |
03.02.2009 |
10.06.2009 |
| Experience at sea: Since 2000 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 889 | Issued: 19.09.2009 | Place: Russia | Exp. date: 19.09.2010 |
| Vaccinationfor cholera valid until: 05.01.2013 | Vaccination for yellow fever valid until: 29.03.2014 | |||