APPLICATION FORM
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APPLICATION FORM |
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| Name: Oleksandr | Surname: Borshchyk | ||||||
| Date of birth: 25.09.1971 | Place of birth: Kherson | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): PO 369253 | Place of issue: Kherson | Date of issue: 02.10.2006 | Valid until: 02.10.2016 | ||||
| Seaman’s book: AB 326706 | Place of issue: Kherson | Date of issue: 10.02.2006 | Valid until: 14.01.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Borshchyk Viktoriya | ||||||
| Supported children under age of 18 | 1. Borshchyk Anastasiya, 15.03.2001 | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kherson Marine College | Engineer | 28.11.2001 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 02186/2003/07 | Nikolaev |
19.12.2003 |
--- |
| Endorsement STCW | 02186/2003/07 | Nikolaev |
05.03.2008 |
20.02.2013 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 05658/2008/42/01 | Nikolaev |
20.02.2008 |
20.02.2013 |
| Advanced Fire Fighting (A-VI/3) | 02496/2008/42/04 | Nikolaev |
20.02.2008 |
20.02.2013 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 04414/2008/42/02 | Nikolaev |
20.02.2008 |
20.02.2013 |
| Medical First Aid (A-VI/4-1) | 01657/2008/42/05 | Nikolaev |
20.02.2008 |
20.02.2013 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. B.Zhadanovskiy | JSSC "Ukrrichflot" | 2850 | Ukraine | Dry cargo |
motorman |
12.04.2004 |
21.08.2004 |
| 2. B.Zhadanovskiy | JSSC "Ukrrichflot" | 2850 | Ukraine | Dry cargo |
3-rd Eng |
10.02.2005 |
05.05.2005 |
| 3. Stefan Gorshkov | JSSC "Ukrrichflot" | 5099 | Ukraine | Dry cargo |
3-rd Eng |
16.05.2005 |
13.07.2005 |
| 4. Vitaliy Primakov | JSSC "Ukrrichflot" | 2850 | Ukraine | Dry cargo |
3-rd Eng |
27.08.2005 |
20.02.2006 |
| 5. Vitaliy Primakov | JSSC "Ukrrichflot" | 2850 | Ukraine | Dry cargo |
3-rd Eng |
19.04.2006 |
27.08.2006 |
| 6. Phu Hai-3 | Antel Investment Ltd | 1400 | Belize | Fishing vessel |
2-nd Eng |
26.10.2006 |
28.10.2007 |
| 7. Volgo-Balt 137 | Fasco International | 2850 | Cambodia | Dry cargo |
3-rd Eng |
30.07.2008 |
13.10.2008 |
| 8. Seaflower | Deep Blue Maritime S.A. | 70000 | MI | Bulk carrier |
3-rd Eng |
18.03.2009 |
28.07.2009 |
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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. A2 |
Skoda |
4 |
1030 |
Skoda |
970/650 |
yes |
no |
| 2. A2 |
Skoda |
4 |
1030 |
Skoda |
970/650 |
yes |
no |
| 3. A2 |
G70 |
4 |
1324 |
Russian diessel |
930/620 |
yes |
no |
| 4. A2 |
SKL |
4 |
1030 |
SKL |
970/650 |
yes |
no |
| 5. A2 |
SKL |
4 |
1030 |
SKL |
970/650 |
yes |
no |
| 6. A2 |
Niagata |
4 |
1800 |
Niagata |
950/630 |
no |
no |
| 7. A2 |
Skoda |
4 |
1030 |
Skoda |
970/650 |
yes |
no |
| 7. A1 |
Sulzer |
2 |
12000 |
Daihatsu |
720/400 |
no |
yes |
| Experience at sea: Since 1991 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ 0563 | Issued: 27.02.2009 | Place: Kherson | Exp.date: 27.02.2010 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 13.10.2016 | |||