|
|
APPLICATION FORM |
|
| Name: Sergiy | Surname: Dyatkov | ||||||
| Date of birth: 08.05.1979 | Place of birth: Ukraine | ||||||
| Permanent address: Melitopol, Ukraine | |||||||
| Passport (OVIR): PO 725549 | Place of issue: Melitopol | Date of issue: 10.04.2007 | Valid until: 10.04.2017 | ||||
| Seaman’s book: AB 356820 | Place of issue: Nikolaev | Date of issue: 14.06.2007 | Valid until: 14.06.2012 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Natalia Dyatkova | ||||||
| Supported children under age of 18 | 1. Elizaveta Dyatkova, 04.07.2002 | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Building Centre | Welder | 05.1997 | |||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00154/2007/06 | Mariupol |
30.07.2007 |
--- |
| Endorsement STCW | 00154/2007/06 | Mariupol |
30.07.2007 |
10.07.2012 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 09474-AS | Mariupol |
10.07.2007 |
10.07.2012 |
| Advanced Fire Fighting (A-VI/3) | 09474-AS | Mariupol |
10.07.2007 |
10.07.2012 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 09474-AS | Mariupol |
10.07.2007 |
10.07.2012 |
| Medical First Aid (A-VI/4-1) | 09474-AS | Mariupol |
10.07.2007 |
10.07.2012 |
| Ro-Ro Passenger ships (A-V/2) | 00154/2007/06 | Mariupol |
30.07.2007 |
10.07.2012 |
| Passenger ships other than Ro-Ro (A-V/3) | 00154/2007/06 | Mariupol |
30.07.2007 |
10.07.2012 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Victor Talalikhin | CFD | 5000 |
Ukraine |
Ro-Ro |
motorman |
08.2007 |
02.2008 |
| Boris Babochkin | CFD | 16000 |
Ukraine |
Gen cargo |
motorman-fitter |
03.2008 |
08.2008 |
| Sumy | CFD | 22900 |
Ukraine |
Bulk carrier |
fitter |
01.2009 |
06.2009 |
| Shakhtar | CFD | 16000 |
Ukraine |
Gen cargo |
fitter |
10.2009 |
03.2010 |
|
Experience at sea: Since 2007 |
Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate # 508 | Issued: 13.08.2007 | Place: Mariupol | Exp.date: | |
| Vaccination for cholera valid until: 2017 | Vaccination for yellow fever valid until: 2017 | |||