Father's name: Anatolevich

АВ APPLICATION FORM

POSITION APPLIED FOR: ___AB____________

Personal data 23.03.2015

Family Name: Shutkin	Name: Bogdan	Father's name: Anatolevich
Date of birth: 22/03/1991	Place of birth: Ukraine, Kherson	Nationality: Ukrainian
Marital status: Single	Children (name & DOB): No
Address : 30 Zerkalnay str., Komushany vill.,Kherson,Ukraine	Tel (including city code):	Mobile; [phone]
Next of kin and relationship: Mother Shutkina Svetlana Nikolaevna
Next of kin’s address : 30 Zerkalnay str., Komushany vill.,Kherson,Ukraine	Tel: + 380506483783
Inter. P’port No: EH092668	Issued: 29/06/2010	Valid: 29/06/2020	Place of issue: Kherson
Seaman's book No: AB418585	Issued: 23/02/2009	Valid: 23/02/2019	Place of issue: Kherson
Civil P’port No: MP224736	Place of issue: Kherson, Ukraine	Date of issue: 11/07/2007
USA Visa No:	Issued:	Valid:	Place of issue:

Medical information

Medical examination	Issued: 16/03/2015	Valid: 16/03/2016	Weight, kg: 83	Height, cm: 184
Drug & alcohol test	Issued: 16/03/2015	Valid: 16/03/2016	Eyes: Brown	Hair: Black
Yellow fever	Issued: 30/07/2015	Valid: 30/07/2025	Overall size: 52	Safety shoes: 44

Name of marine school attended	Address of school	From	To	Degree of diploma
HMCF	55 Lenina str.	01/09/2008	02/07/2011	Navigator

National License

Certificate of competency hold	Number	Issued	Valid	Place of issue
Диплом	12532/2015/07	27.02.2015	unlimited	Nikolayev
Endorsement		10.02.2015	10.02.2020	Nikolayev

IMO	STCW Certificates	Number	Issued	Valid	Place of issue
	AB Endorsement	№ 984	10.02.2015	10.02.2020	Nikolayev
	Carriage of dangerous and hazardous substances	№ 4135	10.02.2015	10.02.2020	Nikolayev
1.08	ARPA (A-I/12, A-II/1, A-II/2, B-I/12)
	Personal safety (A-VI/1) (IMO 1.13, 1.19, 1.20, 1.21)
2.03	Advanced fire fighting (A-VI/3)	№ 12657	08.07.2015	08.07.2020	Illichivsk
1.23	Prof. in survival craft (A-VI/2 p.1-4)	№ 6224	10.02.2015	10.02.2020	Nikolayev
	Designated security duties of shipboard personnel	№ 2031	10.02.2015	10.02.2020	Nikolayev
	Basic training and instruction for all seafarers	№ 7533	10.02.2015	10.02.2020	Nikolayev
	Crane Handling Simulator
1.14	Medical first aid (A-VI/4-1)
1.15	Medical care (A-VI/4-2)
	Hazardous cargoes (B-V/4, B-V/5)
	Safety officer (ISM code)
	Crowd management (A-V/3)
	Bridge Team Management
	Training for person. serving onpassenger ships other than RO-RO pas.ships
	RoRo passenger (A-V/2-1,-2,-3,-4,-5)
	Ship security officer
	Ship handling arrangements
	Свид-ство о повышении квалификации

Dangerous cargoes certificates

1.01	Oil tank. familiarization (A-V/1)
1.02	Oil tank.Specialized training (A-V/1,p.9-14)
1.03	Chem. tank. familiarization (V/1)				.
1.04	Chem. tank. advanced (A-V/1,p.16-21)
1.05	LPG familiarization (V/1)
1.06	LPG advanced (A-V/1,p.23-34)

PREVIOUS SEA SERVICES (last 5 years)

Name of vessel	Year of built	Company	Flag	Type of vessel	DWT	Type of main engine	BHP	Rank	From Day,mont,year	To Day,month,year
RS ”MERKURII”		Christopher Columbus	Ukraine	Dry Cargo				OS	02.07.2009	30.08.2009
m/v “G. Petrovskiy”		Aliance Navigation Marshall Islands Bulk Carrier 31222 OS 08.10.2008 08.04.2009	Ukraine	Dry Cargo				OS	27.06.2010	20.01.2011
m/v “Elans”		Niesko	Ukraine	General Cargo				OS	22.01.2013	10.08.2013
m/v”Almeria”		Staff Centre	LIBERIA	Bulck Carrier				OS	20.10.2013	26.03.2014
m/v”Almeria”		Staff Centre	LIBERIA	Bulck Carrier				OS	15.09.2014	10.03.2015

Another States Seamen’s Books	Rank	Document No	Issued	Valid		Another States Certificates of competency	Rank	Document No	Issued	Valid
Liberia						Liberia
Panama						Panama
Antigua and Barbuda

Please complete addresses of your previous employers for references

Дата добавления: 2015-11-04