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APPLICATION FORM |
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| Name: Sergii | Surname: Bulavka | ||||||
| Date of birth: 28.11.1960 | Place of birth: Kherson | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): AH 820398 | Place of issue: Kherson | Date of issue: 12.10.2000 | Valid until: 12.10.2010 | ||||
| Seaman’s book: AB 358760 | Place of issue: Nikolayev | Date of issue: 29.08.2008 | Valid until: 21.08.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 24.02.2013 | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | daughter - Bulavka Ira | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Kherson Shipbuilding College | Welder | 30.07.1980 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00879 | Illichevsk |
07.10.2004 |
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| Endorsement STCW | 00879 | Kherson |
16.10.2008 |
16.10.2013 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 13652 | Kherson |
18.08.2008 |
18.08.2013 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 06269 | Nikolayev |
24.09.2008 |
24.09.2013 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Sider Sun | Ital Ship | 7500 |
Malta |
Bulker |
fitter |
22.02.2005 |
04.10.2005 |
| Sider Lark | Ital Ship | 21520 |
Napoli |
Bulker |
fitter |
16.05.2006 |
18.11.2006 |
| Stadakona | INCO Ships | 22093 |
Nassau |
CSL |
fitter |
31.08.2007 |
10.10.2007 |
| Atlantic Trader | Atlantic Trader Navigation Ltd | 15893 |
Valletta |
Lo-Ro |
welder |
06.03.2008 |
18.07.2008 |
| Sider Genova | Sider Navi Spa | 12139 |
Napoli |
Bulker |
welder |
14.11.2006 |
21.03.2009 |
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Experience at sea: Since 1999 |
Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | Issued: | Place: | Exp.date: | |
| Vaccination for cholera valid until: | Vaccination for yellow fever | |||