APPLICATION FORM

 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

 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):

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

 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