APPLICATION FORM
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APPLICATION FORM |
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| Name: Mykola | Surname: Borodin | ||||||
| Date of birth: 07.10.1965 | Place of birth: Ukraine | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): AH 839920 | Place of issue: Ukraine | Date of issue: 29.12.2001 | Valid until: 29.12.2011 | ||||
| Seaman’s book: AB 363476 | Place of issue: Kherson | Date of issue: 29.12.2007 | Valid until: 29.12.2012 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Borodina Elena | ||||||
| Supported children under age of 18 | 1. Borodina Karina | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kherson Maritime College | Engineer | 06.07.2004 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00107/2006/07 | Nikolaev |
19.04.2006 |
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| Endorsement STCW | 00107/2006/07 | Nikolaev |
19.04.2006 |
05.04.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 04643 K | Nikolaev |
05.04.2006 |
05.04.2011 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 21401 K | Nikolaev |
05.04.2006 |
05.04.2011 |
| Advanced Fire Fighting (A-VI/3) | 01880 K | Nikolaev |
05.04.2006 |
05.04.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 00930 K | Nikolaev |
05.04.2006 |
05.04.2011 |
| Medical First Aid (A-VI/4-1) | 00874 K | Nikolaev |
05.04.2006 |
05.04.2011 |
| Malta Endirsement | 65135 | Malta |
20.03.2008 |
05.04.2011 |
| Maintenance of Electrical and Electronic Engineering | E 0250/06 KS | Kyiv |
14.04.2006 |
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| Ship Safety Officer | 00918/04 KH | Kherson |
02.07.2004 |
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Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Zheleznyakov | ASC Ukrrichflot | 3000 | Ukraine | Dry cargo |
2-nd Eng |
17.05.2006 |
21.12.2006 |
| 2. Zaporozhec | ASC Ukrrichflot | 3000 | Ukraine | Dry cargo |
2-nd Eng |
09.02.2007 |
11.06.2007 |
| 3. Lieslie | Midland Shipping | 3000 | St.Vincent | Dry cargo |
2-nd Eng |
04.07.2007 |
28.11.2007 |
| 4. Kupiskis | Argo Coral Maritime | 3000 | Malta | Dry cargo |
2-nd Eng |
23.01.2008 |
23.07.2008 |
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Automation (A1/A2) |
Main Eng. Maker/Model |
Engine Stroke |
Engine Total HP |
Aux. Engine Maker/Number |
Aux. Engine H.P. / KW |
Unmanned |
Without El.Eng. |
| 1. |
Skoda |
|
2x600 |
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/ |
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| 2. |
SKL |
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2x700 |
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/ |
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| 3. |
SKL |
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2x700 |
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/ |
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| 4. |
B&M |
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2900 |
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/ |
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| Experience at sea: Since 1987 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ 001576 | Issued: 17.10.2008 | Place: Kherson | Exp.date: 17.10.2009 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 22.10.2018 | |||