APPLICATION FORM
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APPLICATION FORM |
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| Name: Viktor | Surname: Karachynsky | ||||||
| Date of birth: 03.10.1949 | Place of birth: Odessa, Ukraine | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): EA 315529 | Place of issue: Odessa | Date of issue: 12.10.2007 | Valid until: 12.10.2017 | ||||
| Seaman’s book: AB 438431 | Place of issue: Odessa | Date of issue: 27.05.2010 | Valid until: 27.05.2015 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Karachynskaya Tamara - pass. # AH 560270 | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Odessa Secondary Marine School | Ref. Engineer | 27.06.1974 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00022/2007/08 | Odessa |
20.12.2007 |
-- |
| Endorsement STCW | 00022/2007/08 | Odessa |
20.12.2007 |
12.11.2012 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
94874/2007 |
Odessa |
13.11.2007 |
13.11.2012 |
| Advanced Fire Fighting (A-VI/3) |
48369/2007 |
Odessa |
13.11.2007 |
13.11.2012 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
54551/2007 |
Odessa |
12.11.2007 |
12.11.2012 |
| Medical First Aid (A-VI/4-1) |
35428/2007 |
Odessa |
13.11.2007 |
13.11.2012 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Africa Warrior II | West Africa Logitics C.V. |
4194 |
Panama |
Reefer |
Ref. Eng |
20.04.2005 |
21.10.2005 |
| 2. Kasuga Bay | Rosvell Navig. Corp. |
9194 |
Panama |
Reefer |
Ref. Eng |
09.03.2006 |
29.09.2006 |
| 3. Terso | Fair Port Shippinc Co |
4500 |
Panama |
Deep Rif |
Ref. Eng |
03.01.2007 |
22.09.2007 |
| 4. Bristol Bay | Roswell Navigation Corp |
8555 |
Panama |
Reefer |
Ref. Eng |
08.02.2008 |
03.11.2008 |
| 5. Fino | Commercial S.A. |
3687 |
Panama |
Deep Reefer |
Ref. Eng |
24.06.2009 |
14.01.2010 |
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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 |
| 1. A2 |
Hunshin |
|
6500 |
|
6500/ |
| 2. A2 |
Hitachi B&W |
|
12300 |
|
12300/ |
| 3. A2 |
Makita-Mitsui-Man B |
|
4070 |
|
4070/ |
| 4. A2 |
Mitsubishi |
|
8500 |
|
8500/6252 |
| 5. |
Makita-Mitsui-Man B |
|
3800 |
|
3800/ |
| Experience at sea: Since 1974 | Knowledge Personal Computer (Yes / No): | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 28.01.2015 | |||