APPLICATION FORM
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APPLICATION FORM |
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| Name: Vitaly | Surname: Solovyov | ||||||
| Date of birth: 20.11.1971 | Place of birth: Odessa | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AM 647251 | Place of issue: Odessa | Date of issue: 07.03.2000 | Valid until: 07.03.2010 | ||||
| Seaman’s book: AB 339559 | Place of issue: Odessa | Date of issue: 22.05.2006 | Valid until: 22.05.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 02.08.2012 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Lyliya Solovyova | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Kiev State Maritime Academy | Junior Navigator | . | 22.03.2006 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00535/2006/01 | Izmail |
22.03.2006 |
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| Endorsement STCW | 00535/2006/01 | Izmail |
22.03.2006 |
28.02.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 88776 U | Izmail |
31.01.2006 |
31.01.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00117/2006/01 | Izmail |
21.03.2006 |
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| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00117/2006/01 | Izmail |
21.03.2006 |
21.03.2011 |
| Radar Observation and Plotting (A-II/1,2) | 2967 U | Izmail |
17.02.2006 |
17.02.2011 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 2967 U | Izmail |
17.02.2006 |
17.02.2011 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 0659 KS | Izmail |
12.02.2006 |
12.02.2011 |
| Advanced Fire Fighting (A-VI/3) | 38875 U | Izmail |
03.02.2006 |
03.02.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 63671 U | Izmail |
02.02.2006 |
02.02.2011 |
| Medical First Aid (A-VI/4-1) | 35031 U | Izmail |
30.01.2006 |
30.01.2011 |
| Antigua Seaman's book | 38860 | Antigua |
14.04.2004 |
13.04.2009 |
| Antigua Endorsement | 18693D | Oldenburg |
15.08.2007 |
28.02.2011 |
| Antigua G.M.D.S.S. | 17507 R | Antigua |
15.08.2007 |
09.03.2011 |
| AIS | 0042/2008 | Odessa |
05.06.2008 |
05.06.2013 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 2/228/08 | Odessa |
16.05.2008 |
16.05.2013 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Baccara | Marlow Navigation |
2550 |
Antigua |
Multipurp/cont |
AB/Cadet |
22.10.2002 |
05.08.2003 |
| Hagen | Marlow Navigation |
2200 |
Antigua |
Multipurp/cont |
AB/Cadet |
04.05.2004 |
04.11.2004 |
| Bosporus | Marlow Navigation |
2550 |
Antigua |
Multipurp/cont |
AB/Cadet |
27.02.2005 |
12.08.2005 |
| Neermoor | Marlow Navigation |
600 |
Antigua |
Multipurp/cont |
OS/Jun. Off |
22.11.2006 |
05.06.2007 |
| Glacier Bay | Marlow Navigation |
6620 |
Antigua |
Reefer |
3-rd Off |
15.09.2007 |
10.03.2008 |
| Experience at sea: Since 2000 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 00813 | Issued: 09.06.2008 | Place: Odessa | Exp. date: 09.06.2009 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 15.11.2016 | |||