READY TO WORK (DATE):01.11.2017

№

APPLICANT’S PERSONAL DATA

POSITION APPLIED FOR: THIRD MATE	READY TO WORK (DATE): 01. 11. 2017
FIRST / LAST NAME: KOLESNICHENKO ALEXANDER	CITIZENSHIP: RUSSIAN FEDERATION
FATHER’S NAME: ALEXANDROVICH	ADDRESS(incl. post code): 344058 RUSSIA, ROSTOV-ON-DON, STABILNAYA STR. 7, FLT. 415
DATE OF BIRTH: 02. 10. 1984
RELIGION: ORTHODOXAL
PLACE OF BIRTH: USSR
PHONE: MOBILE: +7-951-500-91-87	E-MAIL: sasha. k. 1984@gmail. com SKYPE: alexander-kolesnichenko1

MARITAL STATUS: SINGLE / MARRIED / DEVORSED	NEXT OF KIN: (if not married)
DATE OF MARRIAGE: 16. 12. 2016
WIFE’S FIRST / LAST NAME: KOLESNICHENKO SVETLANA	RELATION: WIFE
FATHER’S NAME: VLADIMIROVNA	FIRST / LAST NAME:
WIFE’S DATE& PLACE OF BIRTH: 14. 09. 1983, USSR	FATHER’S NAME:
ADDRESS: RUSSIA, STABILNAYA STR. 7, FLT. 415	ADDRESS:
PHONE: MOBILE: +7-904-445-50-32	PHONE: MOBILE::

CHILDREN (IF APPLICABLE):
FIRST/ LAST NAME:	DATE OF BIRTH:
KOLESNICHENKO EUGENIA	25. 08. 2005
KOLESNICHENKO KONSTANTIN	10. 08. 2017
FIRST/LAST /MIDDLE NAME of MOTHER	FIRST/LAST /MIDDLE NAME of FATHER
KOLESNICHENKO EUGENIA VIKTOROVNA	KOLESNICHENKO ALEXANDER GRIGORIEVICH

CLOTHES:	SIZES:	HEIGHT		VISA	PLACE OF ISSUE (CITY)	TYPE OF VISA	FROM	VALID TILL
OVERALL		WEIGHT		USA	ST. PETERSBURG	C1/D	26. 06. 2017	21. 06. 2019
SAFETY SHOES		COLOR OF EYES	BROWN	SCHENGEN
TROUSERS		COLOR OF HAIR	BLOND
SWEATER	50-52	CHEST (Cms)
SHIRT	50-52	WAIST (Cms)

MARINE EDUCATION RECEIVED
NAME OF SCHOOL	FROM	TILL	TYPE OF DEGREE RECEIVED
STATE MARITIME UNIVERSITY OF ADMIRAL F. F. USHAKOV			NAVIGATOR

NATIONAL DOCUMENTS (RUSSIAN):	NO.		ISSUED	VALID
SEAFARER’S IDENTITY DOCUMENT	RUS 0301552		08. 10. 2015	07. 10. 2020
SEAMAN’S BOOK	MK 0057301		10. 12. 2010	UNLIMITED
TRAVELLING PASSPORT	71 2370051		02. 11. 2010	02. 11. 2020
CIVIL PASSPORT	6008 123299		25. 12. 2007	25. 12. 2029
	GRADE	NO.	ISSUED	VALID
NAT. LICENCE:	OOW	TAG201642039	31. 08. 2017	11. 07. 2022
ENDORSEMENT: OilChem LPG	OPERATIONAL	TAG201818903	11. 10. 2017	10. 10. 2022
GMDSS:	OPERATIONAL	TAG201641992	31. 08. 2017	30. 08. 2022
ENDORSEMENT:
RADAR OBSERVER:	IMO RES. A483 (XII)		13. 07. 2017	13. 07. 2022
ARPA:	IMO RES. A482 (XII)		17. 07. 2017	17. 07. 2022

CERTIFICATES:

STCW CODE

ISSUED

VAILD TILL

BASIC SAFETY STCW ‘95

A-VI/1

11. 07. 2017

11. 07. 2022

SURVIVAL CRAFT, RESCUE BOATS:

A-V1/2-1

28. 07. 2017

28. 07. 2022

ADVANCED FIRE FIGHTING:

A-V1/3

04. 08. 2017

04. 08. 2022

MEDICAL EMERGENCY FIRST AID

A-V1/4-1

08. 08. 2017

08. 08. 2022

MEDICAL CARE CERTIF.

A-V1/4-2

10. 08. 2017

10. 08. 2022

DESIGNATED SECURITY DUTIES (SSD)

A-VI/6, A-VI/6-2

02. 08. 2017

02. 10. 2022

SHIP SECURITY OFFICER (SSO)

A-VI/5, A-VI/5

31. 01. 2014

31. 01. 2019

BRIDGE TEAM MANAGEMENT / ERM

BRIDGE TEAM MANAGEMENT IMO 1. 22

ECDIS

25. 07. 2017

25. 07. 2022

ECDIS SPECIFIC

OIL TANKER / FAMILIARIZATION /PROG.

A-V/1, P. 2-7

10. 10. 2017

10. 10. 2022

OIL TANKER / SPECIALIZED / PROG.

A-V/1, P. 9-14

CHEM TANKER / FAMILIARIZATION/ PROGR.

A-V/1, P. 2-7

10. 10. 2017

10. 10. 2022

CHEM TANKER /SPECIALIZED/ PROGR.

A-V/1, P. 16-21

LIQUID GAS TANK/FAMILIARIZATION/ PROGR.

A-V/1, P. 2-7

LIQUID GAS TANK/SPECIALIZED / PROGR.

A-V/1, P. 23-34

HAZMAT

B-V/4, B-V/5

16. 08. 2017

16. 08. 2022

HAZMAT (USA-TITLE 49)

26. 05. 2017

26. 05. 2020

CRUDE OIL WASHING OPERATIONS/ INERT GAS SYSTEM

YELLOW FEVER

04. 03. 2015

04. 03. 2025

FLAGS DOCUMENTS:

LIBERIAN

GRADE

NBR

ISSUED

TILL

PANAMANIAN

GRADE

NBR

ISSUED

TILL

SBK

END. TO LIC

END. TO GMDSS

GMDSS

SPECIAL QUALIFICATION

CERTIFICATES

SPECIAL QUALIFICATION

CERTIFICATES

GERMAN

ANT& BARBUDA

SBK

OOW

04. 03. 2014

03. 03. 2019

END. TO LIC

OOW

04. 03. 2014

02. 11. 2017

END. TO GMDSS

GOC

1002507*2022302364

04. 03. 2014

10. 12. 2018

DUTCH

SBK

MARSH. ISLAND

END. TO LIC

SBK

END. TO GMDSS

END. TO LIC

GMDSS

END. TO GMDSS

SPECIAL QUALIFICATION

CERTIFICATES

SPECIAL QUALIFICATION

CERTIFICATES

CYPRUS

MALTA

SBK

END. TO LIC

END. TO GMDSS

BAHAMAS

NIS

END. TO LIC

SBK

END. TO GMDSS

SINGAPORE/ HONG KONG

END. TO LIC

GMDSS

END. TO GMDSS

SPECIAL QUALIFICATION

CERTIFICATES

OTHER DOCUMENTS (NOT MENTIONED BEFORE)
DOCUMENT	GRADE	NO.	ISSUED	VALID

SEA SERVICE LAST 5 YEARS (10 FOR MASTERS AND CHIEF ENGINEERS)
VESSEL’S NAME	COMPANY (SHIP’S OWNER/ CREWING)	FLAG	VSL’S TYPE	TEU/ CARGO	GRT/ DWT	ENG. TYPE	HP/ KW	RANK	EMPLOYMENT (M/Y)		TOTAL
VESSEL’S NAME	COMPANY (SHIP’S OWNER/ CREWING)	FLAG	VSL’S TYPE	TEU/ CARGO	GRT/ DWT	ENG. TYPE	HP/ KW	RANK	FROM	TO	TOTAL
“SAILCOUNTESS”	SAILTRADE	RUSSIAN	D. CARGO	2454mts		SKL		3/O	22/04/2013	05/11/2013	6m14d
“POLLUX”	MARLOW NAV.	A& B	G. CARGO	2452mts		MAK		3/O	21/04/2014	23/10/2014	6m2d
“PRIWALL”	MARLOW NAV.	A& B	G. CARGO	2446mts		DEUTZ		3/O	22/02/2015	07/09/2015	6m12d
“SEATON”	MARLOW NAV.	MARSHALL	BULKER	5164mts		DAIHATSU		3/O	09/12/2015	09/04/2016	4m
“ARA AMSTERDAM”	MARLOW NAV.	GIBRALTAR	MULTI	6154mts		WARTSILA		3/O	25/08/2016	04/11/2016	2m10d
“ZIM RIO GRANDE”	DANAOS	MALTA	CONTAINER	4250TEU		MAN		3/O	10/05/2017	26/09/2017	4m16d

SHIP OWNER’S DATA
COMPANY	TEL	CONTACT PERSON
DANAOS Shipping Co.	+7(812)386-38-01	Tatyana (Crew Department)

CREW AGENCIES DATA
VESSEL	CREW AGENCY	TEL	CONTACT PERSON

С автоматической обработкой моих персональных данных, указанных в анкете, их передачей третьим лицам (включая трансграничную)и хранением в целях трудоустройства в соответствии с Федеральным законом РФ №152-ФЗ согласен. Подтверждаю, что мои персональные данные, указанные в анкете, являются общедоступными.

SIGNATURE OF SEAMAN (подписьморяка): DATE: 30. 10. 2017