Application form for 4th engineer without
experience,motorman or fitter
Readiness
Last salary
1. Personal Data
Surname
Name
Father's Name
Permanent address:
Leonov
Citizenship
Svyatoslav
Date of birth
Volodimir
Place of birth
Ukr.
03.03.1968
Bogyslav Kiev reg.
Date of issue
10.08.2005
27.09.2010
Ap.27 Lazyrnaya42 Mykolayiv Ukraine
Phone:
+380958343838
Mobile: +380952232020 +380501770607
E-mail: Nikolaev-slavik@mail.ru
Place of issue
Mykolayiv
Ilyichevsk
Document
Passport (Travelling)
Seaman’s Book
Liberian S. B.
Panamanian S. B.
Ukrainian Civil Passp.
Other
2. Visas
Country
USA
Australia
No.
EC 246507
AB 413307
CT 641919
EO 318735
19.04.2007
23.05.1997
Londres
Mykolayiv
10.08.2011
1600$
Valid until
10.08.2015
27.09.2015
18.04.2012
---------------
Visa Type/Class
No.
Date Issued
Place Issued
Valid Until
C1/D
C3132444
24.06.2010
Kiev
22.06.2015
Other
3. Marine Education
Full Name of School
Kherson Maritime College
Mykolayiv Maritime school
Crew Department
Appendix 1
Revision 02
Qualification
From
Till
3rd class Engineer
Ship”s welder
10.10.2006
10.04.2000
30.062009
30.10.2000
Page 1 of 4
4. Sea experience (Last 5 years)
Reason of
№ Rank
Vessel
Flag Year of Type of vessel D.W.T
Owner or Management Co /Country
From / To
build
departure
Bulk Carrier
75000
Fir Shipping S.A.
25.04.20 02.11.200 Off.Con
1 Fitter Halo Cygnus Pana 1997
Mars
1981
Tanker
60000
CSL Australia Pty Ltd
08.01.20
16.05.200
Off.Con
2 Fitter Seaway
ma
07
7
tract
Fitter
Port
Mars
2005
Bulk
Carrier
53000
International
Tanker
Management
10.08.20
22.11.200
Off.Con
3
hall
08
8
tract
Baha
1998
Ro-Ro
14000
Condor
Ferries
11.01.20
22.02.200
Off.Con
4 Fitter Commodore
Melbourne
hall
08
8
tract
Isl.
Malta
2009
Bulk Carrier
58000
FBO SA SU France
27.08.20
21.04.201
Off.Con
5 Fitter Tabor
Clipper
mas
09
9
tract
isl.
Malta 2009
Bulk Carrier
58000
Molitor SA SU
16.07.20
16.08.201
Off.Con
6 Motor Molitor
09
0
tract
Genko
Mars 2007
Bulk Carrier
53000
Genco Normandy Limited
11.12.20
23.06201
Off.Con
7 Motor
man
10
0
tract
man
Normandy
hall
10
1
tract
Experience
isl.
Automation
Main Engine
Engine Engine
Aux. Engine
Aux. Engine
№
Crew
Unmanned With El.Eng
(A1/A2)
Maker / Model
StrokeTotal HP/KW
Maker / Model
HP/KW
Yes/No
Yes/No
1 A1
Man B&W 6S60MC
2
8900KW
Daihatsu 5DK-20
400KW
Unicom
2
3
4
5
6
7
Mitsui B&W 6L80GFCA
Man B&W6S50MC-C
Mak 9M32
Man B&W6S50MC-C
Man B&W6S50MC-C7
Man B&W 6S50MC-C
2
2
4
2
2
2
11500KW
9480KW
2*4320KW
7400KW
8700KW
6900Kw
Daihatsu 6DK-20
Daihatsu 6DK-20
Caterpillar
Wartsila 4L20D2
Daihatsu 6DK-20
Daihatsu 6DK-20
550KW
550KW
400KW
645KW
550KW
550Kw
V.Ships
Barber Manninge
Alpha Navigation
Barber Manninge
Barber Manninge
V.Ships
A1
A1
A1
A1
A1
A1
5. Highest Competency certificate held:
Issuing authority
Grade/ STCW’95 Capacity
Certificate No.
Date of issued
Valid until
National Certificate of Comp
Third-class engineer
00878/2009/07
22.07.2009
--------------------
STCW 78/95 Endorsement
Third-class engineer
00878/2009/07
22.07.2009
18.06.2013
National Certificate of Comp
Ship”s Welder
00185/2003/07
13.08.2003
--------------------
STCW78/95 Endorsement
Ship”s Welder
0018/5/2003/07
06.05.2009
18.06.2013
National Certificate of Comp
Motorman
00275/2008/07
18.07.2008
--------------------
Crew Department
Appendix 1
Revision 02
Page 2 of 4
6. Certificates/Courses
Certificates of STCW 78/95
Basic Safety Training and Instruction (A-VI/1)
Carrying Dangerous & Hazardous cargo (B-V/b, B-V/c)
Advanced Fire Fighting (A-VI/3)
Proficiency in Survival Craft, Rescue Boats (A-VI/2-1)
Medical First Aid (A-VI/4-1)
Maintenance of Electrical and Electronic Engineering
Process Control Instrument
Ship safety officer IMOA 741(18)
Ship Security Officer (STCW A – VI/5 and ISPS Code)
Engine Automation
Engine Team and Resource Management
Tanker Certificates
Chemical Tanker specialized training (A-V/1, c.15-21)
Liquefied gas Tanker specialized training (A-V/1, c. 22-34)
Oil Tanker specialized training (A-V/1, c.8-14)
Crude oil washing (STCW 3/9)
Inert gas system (MARPOL 73/78)
Crew Department
Appendix 1
Number
06712/2008/42/01
Date of issue
18.06.2008
Place
Mykolayiv
Expiry date
18.062013
04867/2009/42/04
05339/2008/42/02
03119/2009/42/05
24.06.2009
18.06.2008
24.06.2009
Mykolayiv
Mykolayiv
Mykolayiv
24.06.2014
18.06.2013
24.06.2014
Number
Revision 02
Date of issue
Place
Page 3 of 4
Expiry date
Please complete addresses of your previous employers for references
Company
Address
Barber Manninge
Tel.:+380487840569
11-б Французский б-р Одесса
Signature____________________
Company
Address
Tel.:+380487340340
V.Ships
37/2 Маршала Жукова Одесса
Date 06.07.2011
Nationalities of crew sailed with: Polnish,Filipino,Roumania,Greece
Crew Department
Appendix 1
Revision 02
Page 4 of 4