APPLICATION FORM
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APPLICATION FORM |
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| Name: Sergey | Surname: Buyak | ||||||
| Date of birth: 18.11.1982 | Place of birth: Sevastopol, USSR | ||||||
| Permanent address: Sevastopol, Ukraine | |||||||
| Passport (OVIR): AK 001007 | Place of issue: Sevastopol | Date of issue: 23.03.2004 | Valid until: 23.03.2014 | ||||
| Seaman’s book: AB 250948 | Place of issue: Sevastopol | Date of issue: 29.03.2004 | Valid until: 20.10.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 04.03.2012 | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Buyak Tatyana | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Sevastopol National Technical University | Master's Degree of Engineering | 27.02.2007 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00548/2005/10 | Sevastopol |
17.11.2005 |
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| Endorsement STCW | 00548/2005/10 | Sevastopol |
17.11.2005 |
21.05.2014 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 14709/2010/25/01 | Sevastopol |
08.04.2010 |
08.04.2015 |
| Advanced Fire Fighting (A-VI/3) | 12875/2009/25/04 | Sevastopol |
10.12.2009 |
10.12.2014 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 12874/2009/25/02 | Sevastopol |
10.12.2009 |
10.12.2014 |
| Medical First Aid (A-VI/4-1) | 12876/2009/25/05 | Sevastopol |
10.12.2009 |
10.12.2014 |
| Ro-Ro Passenger ships (A-V/2) | 50329 SV | Sevastopol |
21.05.2009 |
21.05.2014 |
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Tanker Certificate |
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 14719/2010/25/12 | Sevastopol |
08.04.2010 |
08.04.2015 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) | 14721/2010/25/14 | Sevastopol |
08.04.2010 |
08.04.2015 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 14717/2010/25/11 | Sevastopol |
08.04.2010 |
08.04.2015 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Nagoya Bay | Roswel Navigation | 12182 | Panama | Reeefer |
Eng. cadet |
19.03.2006 |
10.08.2006 |
| 2. Atlixco | Five Continents Navigation | 18217 | Panama | Ro-Ro |
Eng. cadet |
22.02.2007 |
06.05.2007 |
| 3. Atlixco | Five Continents Navigation | 18217 | Panama | Ro-Ro |
3-rd Eng |
06.05.2007 |
22.01.2008 |
| 4. Discovery | Yashima Marine Co Ltd | 40489 | Panama | Container |
3-rd Eng |
02.07.2008 |
11.10.2008 |
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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. A2 |
B&W 7L55GD |
2 |
11300 |
Yanmar/2 |
2010/1500 |
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yes |
| 2. A1 |
Sulzer 6RLB76X |
2 |
17043 |
Yanmar/3 |
2010/1500 |
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| 3. A1 |
Sulzer 6RLB76X |
2 |
17043 |
Yanmar/3 |
2010/1500 |
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yes |
| 4. A1 |
B&W 9L80MC |
2 |
37890 |
Daihatsu/3 |
2400/1800 |
yes |
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| Experience at sea: Since 2006 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ 00453 | Issued: 22.05.2009 | Place: Odessa | Exp.date: 22.05.2010 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 23.01.2015 | |||