Ukraine, Kherson

Uritsky Street, 39/17

Mobile phone : +380954521720
E-mail : anton.ismiev@mail.ru

Application Form (Ratings) Position: Second class motorman

Name: Anton Surname: Ismiiev
Date of birth: 23.07.1988 Place of birth: UKRAINE
Permanent address: UKRAINE, KHERSON, Uritsky Street, 39/17
Phone: +380954521720
Passport (OVIR) №: ET 776388 Place of issue: KHERSON Date of issue: 12.03.12 Valid until:12.03.22
Seaman’s book №:AB 501858 Place of issue: KHERSON Date of issue: 20.09.12 Valid until: 11.09.17
Citizenship: UKRAINIAN Expiry date of U.S. visa:
Marital Status: Married Single + Divorced Widower
Next of kin: (name, pas. No) MOTHER- Ismiieva Elena
Supported children under age of 18 1. -
(name, surname, date of birth) 2. -
Knowledge of English language: Very good Good Satisfactory + Fair Poor
Other language knowledge: Russian

Education Qualification No Diploma Date of Issue

Vocational School: Kherson Branch of Second class motorman 00419/2012/11 25.10.2012
Odessa maritime training centre
College: - - -
Academy: - - -

Certificates of STCW 78/95 Yes Place Date of issue Expiry date

Basic Safety Training + KHERSON 25.05.2012 25.05.2017
Proficiency in Survival Craft + KHERSON 01.06.2012 01.06.2017
Proficiency in Fast Rescue Boats
Advanced Fire Fighting
Medical First Aid
Medical Care
GMDSS Certificate
GMDSS Endorsement
Radar Observation & Plotting
Automatic Radar Plotting Aids
Dangerous & Hazardous Cargoes
Hazardous materials
Ships Safety Officer
Ships Security Officer
Isolating Breathing Apparatus
RO-RO Passenger Ship
RO-RO Ship
Oil Tanker Familiarization
1
Oil Tanker Specialized Training
Gas Tanker Familiarization
Gas Tanker Specialized Training
Chem. Tanker Familiarization
Chem. Tanker Specialized Training
Crude Oil Washing
Inert Gas Systems
Bridge Resource Management
Vapor Recovery Systems
Refresher & Updating
Maintenance of Electrical
and Electronic Engineering

Sea service (during five last years):

Name of vessel COMPANY HP/DW Engine Flag Type of Position Period of service
T ’s type vessel From To
Oksiy-56 World Line 1312 SKL UA GC Cadet- 23.06.12 23.08.12
Motorman
Alvadi-1 Impuls LTD 2952 Skoda UA M/V Motorman 11.04.13 06.08.13

National licenses, Flag state passports, licenses, visas and other documents
Document Number Issued Valid Issued Place
CERTIFICATE OF 077295 04.09.12 - KHERSON
COMPETENCY
ENDORSEMENT 077295 04.09.12 - KHERSON

Ukrainian passport AC 956411 24.12.2004 - KHERSON

Experience at sea: 6 month Knowledge Personal Computer (Yes / No): Yes

Medical Certificate № Issued: Place: Exp.date:

013667 07.11.13 Kherson 07.11.14
Vaccination for cholera valid until: Vaccination for yellow fever valid until:
Do you have experience of welding? YES / NO LEVEL OF WELDING FROM 1 – 5 POINTS -

Ready to work from: November

Date: 01.11.2013