APPLICATION FORM
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APPLICATION FORM |
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| Name: Oleksandr | Surname: Korchynsky | |||
| Date of birth: 01.01.1973 | Place of birth: Odessa, Ukraine | |||
| Permanent address: Odessa, Ukraine | ||||
| Passport (OVIR): AM 643604 | Place of issue: Odessa | Date of issue: 27.01.2000 | Valid until: 27.10.2010 | |
| Seaman’s book: AB 289574 | Place of issue: Ilyichevsk | Date of issue: 01.09.2004 | Valid until: 01.09.2009 | |
| Citizenship: Ukraine | Expiry date of U.S. visa : 12.10.2009 | |||
| Marital Status: | Married | |||
| Next of kin: (name, pas. No) | wife - Novakovskaya Tatyana, KK 413385 | |||
| Supported children under age of 18 | 1. Korchynsky Oleksey 28.06.1995 | |||
| (name, surname, date of birth) | . | |||
| Knowledge of English language: | Good | |||
| Education: | Qualification: | No Diploma: | Date of Issue: | |
| Odessa Secondary Marine School | El. Engineer | CK 13908725 | 05.06.2000 | |
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00032/2002/02 | Ilyichevsk |
11.11.2002 |
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| Endorsement STCW | 00032/2002/02 | Odessa |
19.12.2005 |
19.12.2010 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 82396/2005 | Odessa |
22.11.2005 |
22.11.2010 |
| Advanced Fire Fighting (A-VI/3) | 40069/2005 | Odessa |
22.11.2005 |
22.11.2010 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 44204/2005 | Odessa |
23.11.2005 |
23.11.2010 |
| Medical First Aid (A-VI/4-1) | 29427/2005 | Odessa |
22.11.2005 |
22.11.2010 |
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Tanker Certificates: |
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. |
. |
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | LZ02426B | Odessa |
22.11.2005 |
22.11.2010 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | LZ04843B | Odessa |
22.11.2005 |
22.11.2010 |
Sea service (during five last years):
|
N |
Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. | Altair | Tomasos Brothers |
74500 |
Greece |
Bulk |
El.Engineer |
05.12.2002 |
16.09.2003 |
| 2. | Altair | Tomasos Brothers |
74500 |
Greece |
Bulk |
El.Engineer |
25.12.2003 |
27.07.2004 |
| 3. | Antares | Tomasos Brothers |
30000 |
Gibraltar |
Prod Tanker |
El.Engineer |
16.11.2004 |
04.03.2005 |
| 4. | Altair | Tomasos Brothers |
74500 |
Greece |
Bulk |
El.Engineer |
05.03.2005 |
07.11.2005 |
| 5. | Altair | Tomasos Brothers |
74500 |
Greece |
Bulk |
El.Engineer |
18.01.2006 |
20.11.2006 |
| 6. | Normed Amsterdam | Team Ship |
10000 |
Malta |
Multi purp |
El.Engineer |
28.03.2007 |
26.06.2007 |
| 7. | Normed Bremen | Team Ship |
10000 |
Malta |
Multi purp |
El.Engineer |
27.06.2007 |
14.08.2007 |
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N |
Main Eng. Maker/Model |
Engine Total HP |
Aux.Engine Maker/Number,s |
Aux. Engine H.P. / KW |
Voltage (220/380/440) |
Automation class (A1/A2) |
Automation System Maker |
Crane/Maker/ Type/SWL |
Derrick/Maker/ Type/SWL |
| 1. | B&W MAN |
8960 |
Yanmar |
600 |
440 |
A1 |
Nor control |
. |
. |
| 2. | B&W MAN |
8960 |
Yanmar |
600 |
440 |
A1 |
Nor control |
. |
. |
| 3. | B&W MAN |
8000 |
Yanmar |
530 |
440 |
A1 |
Kokosha |
. |
. |
|
4. |
B&W MAN |
8960 |
Yanmar |
600 |
440 |
A1 |
Nor control |
. |
. |
|
5. |
B&W MAN |
8960 |
Yanmar |
600 |
440 |
A1 |
Nor control |
. |
. |
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6. |
MAK |
6000 |
Yanmar |
450 |
440 |
A1 |
Noris |
Libheer 60T |
. |
|
7. |
MAK |
6000 |
Yanmar |
4500 |
440 |
A1 |
Noris |
Libheer 60T |
. |
| Experience at sea: Since 2000 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: 25.03.2007 | Place: Odessa | Exp. date: 25.03.2008 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 2010 | |||
Ready to work from: 10.2007