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APPLICATION FORM |
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| Name: Sergiy | Surname: Bilyy | ||||||
| Date of birth: 23.09.1969 | Place of birth: Doneck reg., Ukraine | ||||||
| Permanent address: Ukraine | |||||||
| Passport (OVIR): EA 180263 | Place of issue: Mariupol | Date of issue: 30.08.2007 | Valid until: 30.08.2017 | ||||
| Seaman’s book: AB 281216 | Place of issue: Mariupol | Date of issue: 18.02.2005 | Valid until: 18.02.2010 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 09.10.2012 | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | |||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Astrakhan Vocational School | motorman | 03.08.1987 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00764/2003/06 | Mariupol |
18.12.2003 |
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| Endorsement STCW | 00764/2003/06 | Mariupol |
24.09.2008 |
16.07.2013 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 108265-AS | Mariupol |
16.07.2008 |
16.07.2013 |
| Advanced Fire Fighting | 21391-AS | Mariupol |
29.05.2009 |
29.05.2014 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 08093-AS | Mariupol |
25.10.2006 |
25.10.2011 |
| Liberia Seaman's book | 07614003 | Liberia |
10.11.2006 |
10.11.2011 |
| Tanker Familiarization | 20885 HC |
05.06.2009 |
05.06.2014 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Georgete K | Santos Maritime | 34670 | Piraeus | Bulk carrier |
oiler |
23.01.2004 |
17.12.2004 |
| Viktoria | A.M.Namikos | 75524 | Panama | Gen cargo |
oiler |
09.03.2005 |
17.10.2005 |
| Agaman | Komrowski | 5562 | Liberia | Container |
oiler |
23.10.2006 |
24.06.2007 |
| Pavian | Komrowski | 74500 | Netherlands | Gen cargo |
oiler |
18.11.2007 |
27.05.2008 |
| Narcea | ERSHIP | 4790 | Portugal | Oil Ch. Tanker |
oiler |
08.06.2009 |
23.12.2009 |
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Experience at sea: Since 1998 |
Knowledge Personal Computer (Yes / No): No | |||
| Medical Certificate | Issued: | Place: | Exp.date: | |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 28.03.2011 | |||