APPLICATION FORM
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APPLICATION FORM |
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| Name: Mykola | Surname: Gutsul | ||||||
| Date of birth: 22.05.1966 | Place of birth: Moldova | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AC 717594 | Place of issue: Odessa | Date of issue: 23.02.2007 | Valid until: 23.02.2017 | ||||
| Seaman’s book: AB 344850 | Place of issue: Odessa | Date of issue: 17.02.1999 | Valid until: 17.02.2009 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Anna | ||||||
| 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 School | motorman | 794 | 07.08.1989 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00014/2004/08 | Odessa |
13.01.2004 |
13.01.2009 |
| Endorsement STCW | 00014/2004/08 | Odessa |
13.01.2004 |
13.01.2009 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 01888B | Odessa |
06.03.2007 |
06.03.2012 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 01331B |
Odessa |
06.03.2007 |
06.03.2012 |
| Ro-Ro Passenger ships (A-V/2) | 00981B | Odessa |
06.03.2007 |
06.03.2012 |
| Passenger ships other than Ro-Ro (A-V/3) | 01308B | Odessa |
31.10.2006 |
31.01.2011 |
| Ship's Welder | 00305/2005/08 | Odessa |
25.04.2005 |
25.05.2010 |
| Ship's Welder Endorsement | 00305/2005/08 | Odessa |
25.04.2005 |
25.05.2010 |
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Tanker Certificates |
. |
. |
. |
. |
| Oil/LPG/Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 0958/2003 | Odessa |
08.12.2003 |
08.12.2008 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Ngol-bego | ABC Marita |
6000 |
Malta |
tanker |
fitter |
04.2004 |
02.2005 |
| 2. Funshal | Classic int. Cruises SA |
10000 |
Portugal |
pass |
fitter |
05.2005 |
05.2006 |
| 3. Athena | Classic int. Cruises SA |
12000 |
Portugal |
pass |
fitter |
11.2006 |
05.2007 |
| 4. Athena | Classic int. Cruises SA |
12000 |
Portugal |
pass |
fitter-welder |
06.08.2007 |
19.09.2007 |
| 5. Sichem New York | EMS |
12000 |
Singapore |
tanker |
fitter-welder |
11.2007 |
04.2008 |
| 6. CPT Costas | Transmed |
175000 |
Cyprus |
bulker |
fitter-welder |
06.2008 |
12.2008 |
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Experience at sea: Since 1991 |
Knowledge Personal Computer (Yes / No): | |||
| Medical Certificate | Issued: | Place: | Exp.date: | |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid unitl: 11.03.2011 | |||
Ready to work from: any time