APPLICATION FORM
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APPLICATION FORM |
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| Name: Valeriy | Surname: Dorosh | ||||||
| Date of birth: 26.02.1979 | Place of birth: Odessa, Ukraine | ||||||
| Permanent address: Belyaevka T., Odessa Reg., Ukraine | |||||||
| Passport (OVIR): EC 560349 | Place of issue: Odessa | Date of issue: 2006 | Valid until: 2016 | ||||
| Seaman’s book: AB 121831 | Place of issue: Odessa | Date of issue: 2006 | Valid until: 2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 22.10.2012 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | Mother - Dorosh Alice | ||||||
| Supported children under age of 18 | 1. Dorosh Vladislav - 01.07.2007 | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Odessa Maritime Academy | Engineer | 04.03.2003 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency (3-rd Engineer) | 00680/2009/01 | Izmail |
05.08.2009 |
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| Endorsement STCW | 00680/2009/01 | Izmail |
05.08.2009 |
06.04.2014 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 2149/2009 | Odessa |
07.04.2009 |
07.04.2014 |
| Carrying Dangerous & Hazardous cargo (B-V/4, B-V/5) | LZ 10167B | Odessa |
16.04.2008 |
16.04.2013 |
| Advanced Fire Fighting (A-VI/3) | 1233/2009 | Odessa |
07.04.2009 |
07.04.2014 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 1710/2009 | Odessa |
06.04.2009 |
06.04.2014 |
| Medical First Aid (A-VI/4-1) | 0454/2009 | Odessa |
08.04.2009 |
08.04.2014 |
| Maintenance of Electrical and Electronic Engineering | 0272/2009 | Odessa |
24.04.2009 |
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| Ro-Ro Passenger ships (A-V/2) | 1/052/09 | Odessa |
13.04.2009 |
13.04.2014 |
| Passenger ships other than Ro-Ro (A-V/3) | 1/060/09 | Odessa |
06.04.2009 |
06.04.2014 |
| Liberia Seaman's book | 0844620 | Virginia |
08.08.2008 |
08.08.2013 |
| Belgium Seaman's book | 1235 | Antwerp |
08.09.2009 |
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| Belgium Endorsement | 680/2009/01 | Antwerp |
14.09.2009 |
06.04.2014 |
| Ship Security Officer | 0234/2006 | Odessa |
21.04.0206 |
21.04.2011 |
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Tanker Certificates |
. | . |
. |
. |
| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 1/031/09 | Illichivsk |
13.04.2009 |
13.04.2014 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) | 1/022/09 | Illichivsk |
02.04.2009 |
02.04.2014 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 1/041/09 | Illichivsk |
13.04.2009 |
13.04.2014 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Eurocarrier | Meditco Shipping Ltd |
12100 |
St.Vincent |
Ro-Ro |
3-rd Eng |
02.10.2005 |
04.04.2006 |
| 2. Vento di Tramontana | BNavi |
8300 |
Panama |
Multipurp |
3-rd Eng |
20.11.2006 |
25.05.2007 |
| 3. Asia Express | Danaos |
52615 |
Liberia |
Container |
3-rd Eng |
04.05.2008 |
29.10.2008 |
| 4. Baracuda 11 | Nazim Shipping Co |
2100 |
Turkey |
Multipurp |
Single Eng |
03.01.2009 |
25.05.2009 |
| 5. Union Supphire | URS Marine Services |
497 |
Belgium |
Tug |
2-nd Eng |
02.09.2009 |
02.01.2010 |
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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 |
Pielstick |
4 |
9100 |
Wartsila/2 |
/2x400 |
|
|
| 2. A1 |
KHD 628V12 |
4 |
6000 |
KHD/3 |
/2x200 |
|
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| 3. A1 |
Sulzer rnd90 |
2 |
2x26800 |
Wartsila/2 |
/2x2000 |
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| 4. A2 |
Man |
4 |
1200 |
Volvo |
/2x150 |
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| 5. A1 |
ABC 8 MDZC |
4 |
5034 |
Scania DS9 95M |
/3x180 |
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Yes |
| Experience at sea: since 1998 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 19.02.2012 | |||