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APPLICATION FORM

 Name: Mykhaylo  Surname: Khomukha
 Date of birth: 17.01.1962  Place of birth: Odessa
 Permanent address: Odessa, Ukraine
 Passport (OVIR): AM 940675  Place of issue: Odessa  Date of issue: 23.10.2000  Valid until: 23.10.2010
 Seaman’s book: AB 332420  Place of issue: Odessa  Date of issue: 19.04.2005  Valid until: 19.04.2010
 Citizenship: Ukraine  Expiry date of U.S. visa: NO
 Marital Status  Married
 Next of kin: (name, pas. No)  wife - Khomukha Olga, KE 456822
 Supported children under age of 18  1. Khomukha Alexandra, 21.03.1990
 (name, surname, date of birth)  .
 Knowledge of English language  Satisfactory
 Education:  Qualification:  No Diploma:  Date of Issue:
 Cherson Marine College   AB  36  21.12.1983

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

04107/2003/08

Odessa

12.11.2003

---

 Endorsement STCW

04107/2003/08

Odessa

28.12.2007

14.12.2012

 Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1)

95317/2007

Odessa

14.12.2007

14.12.2012

 Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2)

54870/2007

Odessa

14.12.2007

14.12.2012

 Advanced Fire Fighting 

48562/2007

Odessa

14.12.2007

14.12.2012

 Carrying Dangerous & Hazardous Substances 

2000/2007

Odessa

14.12.2007

14.12.2012

 Tanker Certificates

 

 

 

 

 Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7)

LZ 03106B

Odessa

25.12.2007

25.12.2012

 LPG carrier (Advanced and Familiarization, A-V/1, p.2-7)

LZ 03106B

Odessa

25.12.2007

25.12.2012

 Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7)

LZ 03106B

Odessa

25.12.2007

25.12.2012

Sea service (during five last years):

Name of vessel

COMPANY

DWT

Flag

Type

Position

From

To

 Magic Swan 

 BGI, V.Ships

28000

Bahamas

Gen cargo

AB

29.11.2002

29.09.2003

 Magic Swan 

 BGI, V.Ships

28000

Bahamas

Gen cargo

AB

01.11.2003

02.06.2004

 Magic Swan 

 BGI, V.Ships

28000

Bahamas

Gen cargo

AB

03.09.2004

06.11.2004

 Magic Swan 

 BGI, V.Ships

28000

Bahamas

Gen cargo

Bosun

06.11.2004

06.03.2005

 Magic Swan 

 BGI, V.Ships

28000

Bahamas

Gen cargo

AB

28.04.2005

27.08.2005

 Magic Swan

 V.Ships

28000

Bahamas

Gen cargo

Bosun

27.08.2005

24.07.2006

 CEC Mistral 

 V.Ships

26000

Bahamas

Gen cargo

AB

27.06.2007

30.11.2007

 Experience at sea:Since 1983   Knowledge Personal Computer (Yes / No):
 Medical Certificate  ¹ 00958  Issued: 15.06.2007   Place: Odessa  Exp.date: 15.06.2008
 Vaccination for cholera valid until:  Vaccination for yellow fever valid until: 14.09.2001 

Ready to work from:  any time

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