APPLICATION FORM
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APPLICATION FORM |
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| Name: Vasyl | Surname: Geyko | ||||||
| Date of birth: 01.01.1956 | Place of birth: Kiev reg. | ||||||
| Permanent address: Krasnogvardeysk, Crimea, Ukraine | |||||||
| Passport (OVIR): 200742 | Place of issue: Crimea | Date of issue: 05.09.2007 | Valid until: 05.09.2017 | ||||
| Seaman’s book: AB 299660 | Place of issue: Ilychevsk | Date of issue: 14.07.2006 | Valid until: 14.07.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Rebryna Sergey | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Liepaya Marine School | Seaman | 1982 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00489/2004/01 |
Sevastopol |
05.09.2007 |
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| Endorsement STCW |
00489/2004/01 |
Sevastopol |
05.09.2007 |
14.07.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
47421/2006 |
Odessa |
05.07.2006 |
05.07.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
86034/2006 |
Odessa |
06.07.2006 |
06.07.2011 |
| Advanced Fire Fighting |
42989/2006 |
Odessa |
05.07.2006 |
05.07.2011 |
| Dangerous cargoes |
1*169/2006 |
Odessa |
06.07.2006 |
06.07.2011 |
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Tanker Certificates |
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) |
2682C |
Sevastopol |
26.06.2009 |
27.06.2014 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) |
2682C |
Sevastopol |
26.06.2009 |
27.06.2014 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) |
2682C |
Sevastopol |
26.06.2009 |
27.06.2014 |
Sea service (during five last years):
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Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| Ghasa |
A1 Reem General Trading Agency |
9844 |
UAE |
Tank |
Bosun |
01.2005 |
05.2006 |
| Asphalt Express |
Emirates Trading Agency LLC |
7284 |
Panama |
Tank |
Bosun |
10.2006 |
07.2007 |
| Rising Om |
Emirates Trading Agency LLC |
5000 |
Panama |
Tank |
Bosun |
03.2008 |
02.2009 |
| Experience at sea: SInce 1982 | Knowledge Personal Computer (Yes / No): No | |||
| Medical Certificate | ¹ 0287 | Issued: 12.10.2009 | Place: Evpatoriya | Exp.date: 12.10.2010 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 2013 | |||