APPLICATION FORM
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APPLICATION FORM |
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| Name: Yury | Surname: Zhak | ||||||
| Date of birth: 28.07.1963 | Place of birth: USSR | ||||||
| Permanent address: Kaliningrad, Russia | |||||||
| Passport (OVIR): 70 0051595 | Place of issue: Russia | Date of issue: 26.07.2007 | Valid until: 26.07.2012 | ||||
| Seaman’s book: ÌÔ 0244577 | Place of issue: Russia | Date of issue: 27.10.2006 | Valid until: 27.10.2011 | ||||
| Citizenship: Russia | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | mother - Zhak Galina | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kaliningrad Higher Engineering Marine College | Engineer-Navigator | 1987 | |||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 1040203266 | Russia |
01.10.2006 |
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| Endorsement STCW | 1040203266 | Russia |
01.10.2006 |
29.09.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 097497 | Russia |
16.10.2006 |
16.10.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 0038282 | Russia |
06.02.2002 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 0038282 | Russia |
06.02.2002 |
29.09.2011 |
| Radar Observation and Plotting (A-II/1,2) | 0079600 | Russia |
29.09.2006 |
29.09.2011 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0079600 | Russia |
29.09.2006 |
29.09.2011 |
| Advanced Fire Fighting (A-VI/3) | 044953 | Russia |
16.10.2006 |
16.10.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 910778 | Russia |
16.10.2006 |
16.10.2011 |
| Ship's Medical Care (A-VI/4-2) | 074346 | Russia |
17.08.2007 |
17.08.2012 |
| Medical First Aid (A-VI/4-1) | 074346 | Russia |
17.08.2007 |
17.08.2012 |
| Germany Seaman's book | 166344 | Hamburg |
06.05.2003 |
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| Liberia Seaman's book | 767559 | USA |
08.01.2007 |
08.01.2012 |
| DP Certificates Induction | IDP 268/08 | Russia |
05.09.2008 |
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| DP Certificates Simulator | SDP 106/08 | Russia |
26.09.2008 |
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Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Condock V | August Bolten |
5000 |
Gibraltar |
Ro-Ro |
2-nd Off |
04.2005 |
11.2005 |
| Maris | Heinz Moje KG |
5350 |
Germany |
Container |
2-nd Off |
01.2006 |
07.2006 |
| Hansa Castella | Leonardt & Blumberg |
21473 |
Liberia |
Container |
2-nd Off |
01.2007 |
06.2007 |
| Gladkov | Gladkov Shipping |
6000 |
Malta |
Bulker |
Ch. Off |
09.2007 |
11.2007 |
| Smith Tide | Tidewater Inc |
1200 |
Vanuatu |
AHTS (DP1) |
Ch. Off |
12.2007 |
01.2008 |
| Kaubturm | Tidewater Inc |
2700 |
Vanuatu |
PSV (DP1) |
Ch. Off |
01.2008 |
03.2008 |
| EAS | EDT Offshore Ltd |
1630 |
Cyprus |
Tug Supply (DP1) |
Ch. Off |
05.2008 |
08.2008 |
| EDT Ares | EDT Offshore Ltd |
2000 |
Limassol |
DSV (DP-2) |
Ch. Off |
09.02.2009 |
14.02.2009 |
| Miclyn Endurance | Miclyn Express Offshore |
2000 |
Singapore |
OSV (DP-2) |
2-nd Off/DPO |
19.03.2009 |
20.07.2009 |
| Bourbon Liberty 107 | Bourbon Offshore |
1500 |
Singapore |
PSV (DP-2) |
Ch. Off/DPO |
29.08.2009 |
14.11.2009 |
| Experience at sea: Since 1983 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 007364 | Issued: 11.08.2009 | Place: Russia | Exp. date: 11.08.2010 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 22.11.2016 | |||