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APPLICATION FORM |
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| Name: Oleksiy | Surname: Kosy | ||||||
| Date of birth: 20.10.1978 | Place of birth: Odessa | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AT 286003 | Place of issue: Odessa | Date of issue: 26.02.2002 | Valid until: 26.02.2012 | ||||
| Seaman’s book: AB 146112 | Place of issue: Odessa | Date of issue: 03.01.2002 | Valid until: 25.05.2011 | ||||
| Citizenship: Ukraine | Expiry date ofU.S. visa: 01.02.2014 | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Mother Kosy Olga | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa Maritime Training Center | Able Seamen | 27024 | 23.11.2001 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00628/2007/03 |
Ilichivsk |
22.03.2007 |
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| Endorsement STCW |
00628/2007/03 |
Ilichisk |
22.03.2007 |
05.05.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
0806/2006 |
Odessa |
05.05.2006 |
05.05.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
42021/2005 |
Odessa |
06.05.2005 |
06.05.2011 |
| Passenger ships other than Ro-Ro (A-V/3) |
1556 |
Odessa |
03.2008 |
03.2013 |
Sea service (during five last years):
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Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| Krymskay |
Cherazmorput |
1000 |
Ukr |
Scow |
AB |
30.07.2003 |
13.05.2004 |
| Stella Quarta |
Lemissoler - Ukraine |
13661 |
Panama |
Bulk |
OS |
10.11.2005 |
12.04.2006 |
| Dream |
Tumco navigation Co |
22945 |
Bahamas |
Pass |
OS |
15.08.2006 |
07.03.2007 |
| Aristides N.P. |
Prospero Maritime |
68952 |
MI |
Bulk |
AB |
06.2007 |
01.2008 |
| Cape Kestrel |
Zodiac Maritime Agencies Ltd |
160000 |
UK |
Bulk |
AB |
06.2008 |
09.2008 |
| Broadgate |
Zodiac Maritime Agencies Ltd |
34600 |
Liberia |
Bulk |
AB |
02.2009 |
08.2009 |
| Experience at sea: Since 2004 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ 610 | Issued: 11.2008 | Place: Odessa | Exp.date: 11.2009 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 04.04.2012 | |||