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AF POSHCHUPAILOV, Aleksandr (RUSSIAN-CHENG-DP2-AHTS-PSV)
- 1. WPIF – M/0120TH APRIL 2015 Rev - 07 Application Form Engineering Officers Section1 Position Position Applied for Chief Engineer Lowest Position Acceptable No Date of Availability 25/10/ 2016 Section2 PersonalDetails Family name / Surname Poshchupailov First Name / Given Name Aleksandr Date & Place of Birth 09/02/1963, Feodosia, USSR Nationality Russian Federation Permanent Address 21/331, Sadovaya st., Tver, Russian Federation Present Address 21/331, Sadovaya st., Tver, Russian Federation PPE information SAFETY SHOES SIZE 44 COVERALL SIZE 3XL Blood Group B(III) Rh- Physical Information HEIGHT 172 WEIGHT 105 Present Contact Number n/a Mobile Number +7 978 022 – 41 - 04 SKYPE ADDRESS alexpaylov963 Email Address alexpaylov@yandex.ru Nearest Airport (and Distance) Simferopol 120 km Section3 Passport Country of Issue Russia Date Issued 04/03/2013 Place Issued FMS 69001, Tver, RF Passport Number 73 0210017 Passport –Expires 04/03/2023 Section4 Seaman Record Book / Seaman ID Issuing Country & Place Russia, Novorossiysk Date Issued Expiry Date Number MK 0024519 04/04/2012 Permanent Seaman ID card RUS 0060559 30/03/2012 29/03/2017 Section5 Next of Kin Full Name / Relationship Rakhmanova Olga, wife Any dependents/ Children (incl age ) Rackmanov Anatoliy, sun, 23 y.o. Address 98100,18/2 Zemskaya st. ,Feodosia, Ukraine Contact Number +38 (06562) 3-29-35
- 2. WPIF – M/0120TH APRIL 2015 Rev - 07 Section6 STCW95 Highest Certificate ofCompetency / Licence Held Class / Grade/Capacity Issuing Country Certificate No. Date Issued Expiry Details of Limitations First Class/3000 kW or more / Chief Engineer Russian Federation 2035500676 23/08/2016 05/07/2021 UNLIMITED Section7 STCW95 Dangerous CargoEndorsements Petroleum……………. Liquefied Gas………. Liquid Chemicals……. Certificate No. Date Issued Expires Details of Limitations/ Grade Section8 STCW95 relatedCourses Attended and Certificates Obtained Name of Course / Certificate STCW Code Place Issue Date Cert No Expiry Date Basic Safety Training A-VI/1 Astrakhan, Russia 05/07/2016 0532298 05/07/2021 Basic Sea Survival / Personal Survival Techniques A- VI/1-1 Fire Prevention & Fire Fighting A-VI/1-2 Elementary First Aid A-VI/1-3 Personal Safety & Social Responsibility A-VI/ 1-4 Proficiency in Survival Craft & Rescue Boats A-VI/ 2-1 Astrakhan, Russia 06/07/2016 0596406 06/07/2021 Proficiency in FAST RESCUE BOATS A-VI/ 2 Advanced Fire Fighting A-VI/ 3 Astrakhan, Russia 07/07/2016 0494056 07/07/2021 Medical & First Aid A-VI/ 4-1 Astrakhan, Russia 12/07/2016 0415101 12/07/2021 Proficiency in Security Awareness A-VI Proficiency in Designated Security Duties A-VI/6 Astrakhan, Russia 13/07/2016 0597516 13.07.2016 Medical Certificate / HEALTH Certificate MLC Compliant Astrakhan, Russia 19/09/2016 N/A 19/09/2017 Drug / Alcohol test certificate Astrakhan, Russia 19/09/2016 N/A 19/09/2017 YELLOW FEVER Odessa, Ukraine 22/06/2011 22/06/2021 ISM Code A.1441 (18) Engine Room Resources Management ( Operational Level / Management level ) A-III/1,A-III/2, A-III/3,A-VIII/2 HELM(leadership and management skills ) A-II/2, A-III/2 Carriage of dangerous and hazardous substances B-V/b and B-V/c Astrakhan, Russia 22/07/2016 22/07/2021
- 3. WPIF – M/0120TH APRIL 2015 Rev - 07 Section9 OFFSHORE INDUSTRYCOURSES Please enter below any other certificates held or courses done,ie offshore, DP certs etc or Any other not already mentioned Name of Course / Certificate APPROVALS Place Issue Date Cert No Expiry BOSIET / FOET HUET OFFSHORE MEDICALS ( UK, NORWAY or NETHERLAND ) Re-Breather training Initial Standby vessel crews training ( ITSO ) CAA (Civil Aviation Authorities – Helicopter) Advanced Medical Aider ( AMA ) HLO BASIC H2S TRAINING McDermott Middle East Inc. Sharjah, UAE 16/04/2016 20131-1 17.04.2017 MARLIN’s English Test Score: 93% Sevastopol, Ukraine 26/07/2011 20BB76CF9 F724543 Permanent IELTS-English TEST http://www.ielts.org/test_centre_search/search_results.aspx SCORE PMS maintenance system – Confirm that you are Familiar with its use ( YES / NO ) Yes DEEP WATER ANCHOR HANDLING EXPERIENCE ENTER DEPTH IN METERS 40 – 100 DP Maintenance Courses Odessa Maritime Training Centre Odessa, Ukraine 22/06/2011 0069/ 2011 Permanent HIGH VOLTAGE COURSE Dynamic Positioning Induction Course Dynamic Positioning Simulator Course Dynamic Positioning Operators CERTIFICATE Full or Limited Dynamic Positioning Log book Details Section10 Hours done with various DP system SYSTEM DETAILS Approx Hours as SDPO / Approx Days in case of Senior ETO / Senior Engineer Approx Hours as DPO / Approx Days in case of Junior ETO / Junior Engineer APPROXIMATE Total DP Hours in Various Operations SAT DIVING CABLE LAYING AIR DIVING SURVEY ROV PIPE LAYING WELL STIMULATION/ INTERVENTION/ ACTIVATION DRILL SHIP / SEMI SUB AHTS 1000 PSV 200 FPSO SHUTTLE TANKER CONSTRUCTION ROCK DUMPING / MATTRESSING CORING TRENCHING HEAVY LIFT ACCOMMODATION/ GANGWAY
- 4. WPIF – M/0120TH APRIL 2015 Rev - 07 Section 11 Medical History YES NO 1. Have you ever signed off a ship due medical reason and been hospitalised? X 2. Have you ever been signed off the vesseland repatriated due illness? X 3. Have you undergone any medical operations in past? X 4. Have you consulted a doctor during the past 12 months for an illness / Accident X 5. Do you have any health or disability problem now?? X 6. Any Past MedicalCondition – Which May Affect Your Work :- (If Yes Than Please Specify Below) X 7. Do you feel healthy and fit to perform the duties of your designated position/occupation? X 8. Are you allergic to any medications?- If Yes,then please identify below X Allergic to Medications : X 9. Are you taking any non-prescription or prescription medications at present? X If yes, please list the medications taken, and the purpose(s) and dosage(s): PRESCRIPTION MEDICATION: NON-PRESCRIPTION MEDICATION: If answer to any of above is YES then give further details below or on a separate sheet NOTE : All our clients have STRICT Alcohol and Drug Policy, Which means ZERO TOLERENCE for alcohol and drugs Section 12 General Yes No Have you ever been involved in a maritime accident, ie grounding, fire, Explosion, Collision.etc X Have you ever been the subject of a court of enquiry or involved in a maritime accident X Have you ever had a professional licence suspended or revoked X Have you ever been convicted of any criminal offence? X Have you ever been dismissed due any reason X If yes to any of above then please full details below or on separate sheetofpaper Section 13 PROVIDE DETAILS OF YOUR LAST EMPLOYER, IN ORDER TO OBTAIN CONFIRMATION ON YOUR SEA SERVICES Name of company ATLANTIC MARITIME GROUP Name Person to be contacted Port Engineer Mr. Hassan Sharafi Address P.O.Box:6653, Sharjah, UAE Tel No Mob : +971 504625758 Fax Fax : +971 6 5260292 Email hassan@amguae.net Name of company Name Person to be contacted Address Tel No Fax EMAIL Section 14 Any other information, you wish to add in support of your application Section 15 Declaration – MUST BE SIGNED BY ALL APPLICANTS I hereby declare that the above particulars are true and I authorize you to contact thereferees listed above And confirm that All my certificates /Licences are Authentic/ SEASERVICE RECORD is ACCURATE / And I confirm accepting Companies DRUG & ALCOHOL Policy Signed: Aleksandr Poshchupailov Date:24.10.2016
- 5. WPIF – M/0120TH APRIL 2015 Rev - 07 Section16 Recordof Full Sea Service (All Dates to be entered as dd/mm/yy) Please give full record of sea service STARTING FROM LAST VESSEL FIRST VESSEL COMPANY Type of Vessel And Type of operation in case of DP vessels GRT Type of Engines Or DP System BHP RANK Sign on DATE Sign off DATE dd / mm / yy dd / mm / yy NAUTICAL TIDE TIDE WATER ROV DP-2 2367 CAT3512 4 X 1000 Chief Engineer 15/04/2016 15/05/2016 ES THUNDER AMG AHTS,CPP DP-2 2081 MAK 8M25 2 X 3264 Chief Engineer 14/04/2015 17/05/2015 ALLIANZ ARISTON STANFORD MARINE OSV ASD DP-1 1671 WARTSILA 8L20 2 X 2200 Chief Engineer 04/06/2014 07/09/2014 ALLIANZ ARISTON STANFORD MARINE OSV ASD DP-1 1671 WARTSILA 8L20 2 X 2200 Chief Engineer 22/01/ 2014 09/04/2014 STANFORD GOLD STANFORD MARINE PSV,FPP 1094 CAT 3512 2 X 1500 Chief Engineer 12/06/2013 19/09/2013 STANFORD KITE STANFORD MARINE PSV ASD DP-I 1387 CUMMINS QSK60-M 2 x2000 Chief Engineer 03/10/2012 17/12/2012 STANFORD KITE STANFORD MARINE PSV ASD DP-I 1387 CUMMINS QSK60-M 2 x2000 Chief Engineer 16/04/2012 13/07/2012 STANFORD GOSHAWK STANFORD MARINE PSV ASD DP-I 1399 CUMMINS QSK60-M 2 x2000 Chief Engineer 26/10/2011 20/01/2012 CHIPLUN SVITZER TUG BOAT, FPP 424 NIIGATA 6L26 HLX 2 x 2241 Chief Engineer 22/09/2010 16/01/2011 SVITZER MERMAID SVITZER ASD TUG BOAT 305 WÄRTSILÄ NOHAB WN8V25 2 x 1999 Chief Engineer 28/05/2010 25/08/2010 SVITZER NABIH SALEH SVITZER ASD TUG BOAT 332 YANMAR 8N21A 2 x 2282 Chief Engineer 31/10/2009 11/02/2010 GALF MALLARD TIDE WATER ASD TUG BOAT 411 WÄRTSILÄ NOHAB WN8V25 2 x 2000 Chief Engineer 16/04/2009 16/08/2009 OIL PUMA TIDE WATER PSV,CPP 859 YANMAR 6Z- ST 2 x 2176 Chief Engineer 20/10/2008 14/01/2009
- 6. WPIF – M/0120TH APRIL 2015 Rev - 07 DONNELY TIDE TIDE WATER AHTS, CPP DP-I 1860 MAK 9M25 2 x 4039 Chief Engineer 29/05/2008 27/06/2008 OIL PANTER TIDE WATER PSV, CPP 836 YANMAR 6Z- ST 2 x 2176 Chief Engineer 24/04/2008 28/05/2008 PLATT TIDE TIDE WATER AHTS, CPP DP-I 1857 MAK 9M25 2 x 4039 Chief Engineer 25/01/2008 24/04/2008 OIL TYPHOON TIDE WATER AHTS, CPP DP-I 985 WÄRTSIL NOHAB WN8V25 2 x 2040 Chef Engineer 22/06/2007 22/10/2007 PATTAROZZI TIDE TIDE WATER PSV ASD DP-I 1888 CATERPILLAR 2 x 2392 2-nd Engineer 25/04/2007 21/06/2007 PLATT TIDE TIDE WATER AHTS, CPP DP-I 1857 CATERPILLAR 9M25 2 x 4039 2-nd Engineer 14/04/2006 17/07/2006 GOLDBLATT TIDE TIDE WATER AHTS, CPP DP - 2 1800 WÄRTSILÄ NOHAB WN8V25, 2 x 3000 2-nd Engineer 03/10/2005 27/01/2006 GOLDBLATT TIDE TIDE WATER AHTS DP - 2 1800 WÄRTSILÄ NOHAB WN8V25, 2 x 3000 2-nd Engineer 26/04/2005 26/07/2005 SCHAARTOR TIDE WATER AHTS, CPP 1142 MAK 6M25 2 x 2038 2-nd Engineer 28/09/2004 05/02/2005 NEFTEGAZ-52 FAR EAST MARINE COMPANY – FEMCO AHTS, CPP 2723 ZULCERZL 40/48 2 x 3600 2-nd Engineer 20/05/2003 20/10/2003 NEFTEGAZ-52 FEMCO AHTS, CPP 2723 ZULCER ZL 40/48 2 x 3600 2-nd Engineer 06/03/2002 19/09/2002 NEFTEGAZ-52 FEMCO AHTS, CPP 2723 ZULCER ZL 40/48 2 x 3600 3-rd Engineer 19/02/2001 05/06/2001 NEFTEGAZ-16 FEMCO AHTS, CPP 2723 ZULCER ZL 40/48 2 x 3600 3-rd Engineer 28/03/2000 04/08/2000 NEFTEGAZ-16 FEMCO AHTS, CPP 2723 ZULCER ZL 40/48 2 x 3600 3-rd Engineer 31/07/1999 10/11/1999
- 7. WPIF – M/0120TH APRIL 2015 Rev - 07 NEFTEGAZ- 70 FEMCO AHTS, CPP 2723 ZULCER ZL 40/48 2 x 3600 3-rd Engineer 09/12/1998 24/03/1999 NEFTEGAZ- 60 FEMCO AHTS, CPP 2723 ZULCER ZL 40/48 2 x 3600 3-rd Engineer 10/05/1997 22/01/1998 NEFTEGAZ- 16 FEMCO AHTS, CPP 2723 ZULCER ZL 40/48 2 x 3600 3-rd Engineer 18/05/1996 07/12/1996 From 04/07/1994 to 15/05/1996, I worked in Vietnam for ” VIETSOVPETRO ” as the diesel engines maintenance engineer for the shore & oil rigs power plants. NEFTEGAZ - 28 FEMCO AHTS, CPP 2723 ZULCER ZL 40/48 2 x 3600 3-rd Engineer 20/07/1993 16/06/1994 NEFTEGAZ - 27 FEMCO AHTS, CPP 2723 ZULCER ZL 40/48 2 x 3600 3-rd Engineer 22/12/1992 10/06/1993 NEFTEGAZ-6 FEMCO AHTS, CPP 2723 ZULCER ZL 40/48 2 x 3600 4-th Engineer 05/02/1991 20/03/1992 MARINA CVETAEVA FEMCO Passenger ship, CPP 4575 ZULCER ZL 40/48 4352 4-th Engineer 12/08/1989 28/01/1990 TITAN - 5 FEMCO Crane ship, VP 4315 211D-ЗМ 3400 4-th Engineer 23/12/1988 05/08/1989 NEFTEGAZ- 14 FEMCO AHTS, CPP 2723 ZULCER ZL 40/48 2 x 3600 4-th Engineer 14/06/1987 28/03/1988 NEFTEGAZ- 52 FEMCO AHTS, CPP 2723 ZULCER ZL 40/48 2 x 3600 4-th Engineer 11/02/1987 30/04/1987 VIKHR - 6 FEMCO Fire/Resсue vessel, CPP 2430 ZULCER ZL 40/48 2 x 2937 4-th Engineer 12/05/1986 07/12/1986 POISK FEMCO Research ship, CPP 758 8NVD48-A2U 1200 3-th Engineer 24/10/1984 22/08/1985
- 8. WPIF – M/0120TH APRIL 2015 Rev - 07
- 9. WPIF – M/0120TH APRIL 2015 Rev - 07 ADDITIONAL INFORMATION SHEET VESSELTYPE YOU ARE INTERESTEDIN (please list in order of priority) 1.AHTS 2.PSV 3.OSV 4. 5. MAXIMUM ACCEPTABLE CONTRACT PERIOD(Please indicate below) 3 month +1 Please Quote –Consolidated MINIMUM MONTHLY SALARY( no leave pay ) payable for time onboard only or Working DAY RATE EXPECTATION( no leave pay) (please quote below in US$ -preferred or Euro or GBP£ ) 350 USD or 300 Euro Languages Spoken / Written / Understood (1-poor 5-Fluent) Spoken Written Understood ENGLISH – MARLINS 93% 5 4 4 DRUG & ALCOHOL POLICY ALL Our Clients have very strict NO DRUG and ALCOHOL POLICY, Which is required to be complied with at all times, which means “””ZERO TOLERENCE on ALCOHOL & DRUG””” Your body must NOT have any ALCOHOL or DRUG substances from the time you board your flight or commence your travel to join vessel, and Must remain so Until you have completed full contract and returned to your home Airport / Town If during the said period you are found under the influence of DRUG or ALCOHOL then ALL EXPENCES incurred which will include all your travel and recruiting costs, And your relief’s Travel and recruiting costs, And Any other costs whatsoever incurred due to your NON- COMPLIANCE will be deducted from your salary, Which will include but not limited to “damage to vessel her equipments and machineries, loss of charter, and any other costs Directly or indirectly connected with your NON-COMPLIANCE Sign &CONFIRM ACCEPTANCE OF ABOVE POLICY……………………………………… FOLLOWING DOCUMENTS COPIES MUST BE SENT TO US- send to us In separate Email All Certificates / Courses Listed in this form + Licence or Certificate of competency, Any tanker endorsements, GMDSS showing expiry date in case of Deck Officers, Medical Fitness / Examination Certificate, Passport Main page, Seaman book or Discharge book Main pages, In case of DPO – DPO Cert, DP LOGPages FOLLOWING ADDITIONAL DOCUMENTS will ALSO BE REQUIRED–Send to us in separate email All short courses certificates ( STCW95 ), SSO certificate, Last 3-5 years ships entries in Discharge book or Seaman book, Certificate of Equivalent Competency from other flag states