APPLICATION FORM
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APPLICATION FORM |
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| Name: Sergiy | Surname: Krivchykov | ||||||
| Date of birth: 13.04.1967 | Place of birth: Russia | ||||||
| Permanent address: Sevastopol, Ukraine | |||||||
| Passport (OVIR): EK 955571 | Place of issue: Sevastopol | Date of issue: 06.05.2010 | Valid until: 06.05.2020 | ||||
| Seaman’s book: AB 314083 | Place of issue: Sevastopol | Date of issue: 23.01.2009 | Valid until: 23.01.2014 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 13.04.2013 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Krivchykova Lyudmila - wife | ||||||
| Supported children under age of 18 | Elena - 24.07.1993 | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Sevastopol Apparatus Build Institute | Marine Engineer | 21.06.1991 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00072/2006/09 | Sevastopol |
15.05.2006 |
--- |
| Endorsement STCW | 00072/2006/09 | Sevastopol |
14.01.2009 |
11.05.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 13347C | Sevastopol |
08.01.2009 |
09.01.2014 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 15102C | Sevastopol |
09.01.2009 |
09.01.2014 |
| Advanced Fire Fighting (A-VI/3) | 05611C | Sevastopol |
09.01.2009 |
09.01.2014 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 08538C | Sevastopol |
09.01.2009 |
09.01.2014 |
| Medical First Aid (A-VI/4-1) | 04198C | Sevastopol |
09.01.2009 |
09.01.2014 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Forest Venture | Lemissoler Shipmanagement | 8453 | Cyprus | Ro-Ro |
3-rd Eng |
15.05.2005 |
03.10.2005 |
| 2. Stella Quatra | Lemissoler Shipmanagement | 22669 | Panama | Bulk |
3-rd Eng |
13.11.2005 |
10.02.2006 |
| 3. African Evergreen | Seaboard Ship Management Inc | 9122 | Liberia | Bulk |
2-nd Eng |
05.07.2006 |
23.11.2006 |
| 4. Seaboard Victory | Seaboard Ship Management Inc | 14454 | Panama | Ro-Ro |
2-nd Eng |
25.01.2007 |
25.05.2007 |
| 5. Hanse Vision | Johs Thode GmbH | 9604 | Cyprus | Cont |
2-nd Eng |
21.10.2007 |
30.01.2008 |
| 6. Hanse Spirit | Johs Thode GmbH | 9604 | Cyprus | Cont |
2-nd Eng |
18.04.2008 |
07.08.2008 |
| 7. Maersk Duisburg | Leonardt&Blumberg | 62399 | Germany | Cont |
2-nd Eng |
07.12.2008 |
29.12.2008 |
| 8. Maruba Parana | Leonardt&Blumberg | 23420 | Liberia | Cont |
2-nd Eng |
14.03.2009 |
15.07.2009 |
| 9. Niledutch Shenzhen | Leonardt&Blumberg | 23464 | Liberia | Cont |
2-nd Eng |
23.12.2009 |
03.04.2010 |
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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 |
Pielstic |
4 |
7000 |
Daihatsu/3 |
3x900/ |
no |
no |
| 2. A2 |
Pielstic |
4 |
8000 |
Yanmar/3 |
2x430/270 |
no |
no |
| 3. A2 |
Mitsubishi |
2 |
5200 |
Yanmar/3 |
2x470/ |
no |
yes |
| 4. A2 |
Mitsubishi |
2 |
12600 |
Yanmar/3 |
3x1200/ |
no |
no |
| 5. A1 |
Wartsila |
4 |
12391 |
Mitsubishi/2 |
2x725/ |
yes |
yes |
| 6. A1 |
Wartsila |
4 |
12391 |
Mitsubishi/2 |
2x725/ |
yes |
yes |
| 7. A1 |
Hyunday Man B&W |
2 |
58600 |
Hyunday Wartsila/3 |
3x2930/ |
yes |
no |
| 8. A1 |
Hyunday Man B&W |
2 |
20520 |
Holeby Man B&W/3 |
3x1260/ |
yes |
no |
| 9. A1 |
HHM Man B&W |
2 |
22324 |
Holeby Man B&W/3 |
3x1260; 1x1260/ |
yes |
no |
| Experience at sea: Since 1991 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ 4495 | Issued: 18.11.2009 | Place: Sevastopol | Exp.date: 18.11.2010 |
| Vaccination for cholera valid until: 4.01.2015 | Vaccination for yellow fever valid until: 07.10.2014 | |||