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APPLICATION FORM |
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| Name: Hennadiy | Surname: Lyulka | ||||||
| Date of birth: 26.08.1952 | Place of birth: Simferopol | ||||||
| Permanent address: Sevastopol, Ukraine | |||||||
| Passport (OVIR): EA 829977 | Place of issue: Sevastopol | Date of issue: 28.03.2008 | Valid until: 28.03.2018 | ||||
| Seaman’s book: AB 389643 | Place of issue: Sevastopol | Date of issue: 27.03.2008 | Valid until: 27.02.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Suslova Olga, AP 274884 | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| SDI Sevastopol | Shipbuilding Engineer | . | 1974 | ||||
| SNTU Sevastopol | Refrigerating Engineer | . | 2000 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00028/2008/10 | Sevastopol |
12.03.2008 |
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| Endorsement STCW | 00028/2008/10 | Sevastopol |
12.03.2008 |
01.09.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 10486 C | Sevastopol |
01.09.2006 |
01.09.2011 |
| Advanced Fire Fighting (A-VI/3) | 04100 C | Sevastopol |
01.09.2006 |
01.09.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 05067 C | Sevastopol |
01.09.2006 |
01.09.2011 |
| Medical First Aid (A-VI/4-1) | 02713 C | Sevastopol |
01.09.2006 |
01.09.2011 |
| Certificate of electrogaswelder | 116/2002 | Sevastopol |
14.06.2002 |
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| Panama Seaman's Book | 489490 PG | Panama |
05.07.2007 |
05.07.2012 |
| Liberia Seaman's Book | 0767085 | Virginia |
03.01.2007 |
03.01.2012 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Spring Dragon | Roswell Nav. Corp | 12780 | St.Vincent | Reefer |
Ref. Eng |
26.04.2004 |
27.07.2004 |
| 2. Cristal Hope | Roswell Nav. Corp | 5400 | Panama | Reefer |
Ref. Eng |
12.10.2004 |
21.06.2005 |
| 3. Barents Bay | Roswell Nav. Corp | 7730 | Panama | Reefer |
Ref. Eng |
29.10.2005 |
19.05.2006 |
| 4. Barents Bay | Roswell Nav. Corp | 7730 | Panama | Reefer |
Ref. Eng |
15.11.2006 |
25.04.2007 |
| 5. Bristol Bay | Roswell Nav. Corp | 7730 | Liberia | Reefer |
Ref. Eng |
14.07.2007 |
11.02.2008 |
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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. |
- |
- |
- |
- |
- |
. |
. |
| 2. |
- |
- |
- |
- |
- |
. |
. |
| 3. |
- |
- |
- |
- |
- |
. |
. |
| 4. |
- |
- |
- |
- |
- |
. |
. |
| 5. |
- |
- |
- |
- |
- |
. |
. |
| Experience at sea: Since 1983 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ 4322 | Issued: 10.04.2008 | Place: Sevastopol | Exp.date: 10.04.2009 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||
Ready to work from: any time