APPLICATION FORM
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APPLICATION FORM |
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| Name: Alexander | Surname: Zaderey | ||||||
| Date of birth: 19.01.1971 | Place of birth: Kaliningrad | ||||||
| Permanent address: Rostov-on-Don, Russia | |||||||
| Passport (OVIR): 62 1333592 | Place of issue: Rostov-on-Don | Date of issue: 30.09.2004 | Valid until: 30.09.2009 | ||||
| Seaman’s book: RF 0055963 | Place of issue: Taganrog | Date of issue: 12.10.2001 | Valid until: 12.10.2011 | ||||
| Citizenship: Russia | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | Kubasheva Svetlana | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Sedov Marine College | Technical Navigator | 1991 | |||||
I'm working with my wife: Kubasheva Svetlana
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 2020105901 | Taganrog |
07.09.2009 |
--- |
| Endorsement STCW | 2020105901 | Taganrog |
07.09.2009 |
29.06.2014 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 79150 | Rostov-on-Don |
04.07.2006 |
04.07.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 756 | Rostov-on-Don |
15.07.2004 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 756 | Rostov-on-Don |
15.07.2004 |
05.06.2014 |
| Radar Observation and Plotting (A-II/1,2) | 80568 | Rostov-on-Don |
30.11.2006 |
30.11.2011 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 78550 | Rostov-on-Don |
14.07.2006 |
14.06.2011 |
| Advanced Fire Fighting (A-VI/3) | 043613 | Rostov-on-Don |
29.06.2006 |
29.06.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 048488 | Rostov-on-Don |
04.07.2006 |
04.07.2011 |
| Medical First Aid (A-VI/4-1) | 049603 | Rostov-on-Don |
05.07.2006 |
05.07.2011 |
| Ship's Medical Care (A-VI/4-2) | 049603 | Rostov-on-Don |
05.07.2006 |
05.07.2011 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Corvus | VMT |
6000 |
Russia |
Gen cargo |
Ch. Off |
14.11.2005 |
10.03.2006 |
| N. Sutyrin | Sovfracht |
5000 |
Mongol |
Gen cargo |
Ch. Off |
29.07.2006 |
11.10.2006 |
| Ulusland 1 | Albros |
3000 |
Russia |
Gen cargo |
Ch. Off |
07.11.2006 |
13.01.2007 |
| Glory | IBS |
2000 |
St. Vincent |
Gen cargo |
Ch. Off |
07.06.2007 |
14.09.2007 |
| Maranjos | Stan Shipping |
2500 |
Panama |
Reefer |
Ch. Off |
08.01.2008 |
15.05.2008 |
| Karla Omayra | Sea Lane |
9800 |
N. Antilles |
Ro-Ro/Heavy lift |
Ch. Off |
05.06.2008 |
05.10.2008 |
| Mariner | Leros Management |
26000 |
Malta |
Bulker |
Ch. Off |
11.11.2008 |
28.02.2009 |
| Experience at sea: Since 1991 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 722 | Issued: 05.07.2006 | Place: Rostov-on-Don | Exp. date: 05.07.2011 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||