APPLICATION FORM
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APPLICATION FORM |
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| Name: Serhiy | Surname: Molyboha | ||||||
| Date of birth: 03.09.1985 | Place of birth: Ukraine | ||||||
| Permanent address: Kerch, Ukraine | |||||||
| Passport (OVIR): EC 818964 | Place of issue: Simferopol | Date of issue: 23.11.2006 | Valid until: 23.11.2016 | ||||
| Seaman’s book: AB 252426 | Place of issue: Kerch | Date of issue: 20.01.2005 | Valid until: 20.01.2015 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Molyboha Nataliya | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kerch High Marine School | Operation of shippower Installations | 01.09.2000 | |||||
| Nikolayev Shipbuilding University | Operation of shippower Installations | 01.09.2005 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00149/2008/07 | Nikolayev |
20.02.2008 |
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| Endorsement STCW | 00149/2008/07 | Nikolayev |
20.02.2008 |
12.12.2012 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 05167/2007/42/01 | Nikolayev |
12.12.2007 |
12.12.2012 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 14147 | Kerch |
12.12.2007 |
12.12.2012 |
| Advanced Fire Fighting (A-VI/3) | 02218/2007/42/04 | Nikolayev |
12.12.2007 |
12.12.2012 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 03978/2007/42/02 | Nikolayev |
12.12.2007 |
12.12.2012 |
| Medical First Aid (A-VI/4-1) | 01480/2007/42/05 | Nikolayev |
12.12.2007 |
12.12.2012 |
| Ship Safety Officer | 22268 | Kerch |
05.10.2009 |
05.10.2014 |
| Ship Security Officer | 12261 | Kerch |
05.10.2009 |
05.10.2014 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Vimpel | Shipyard 'Zaliv' | Ukraine | Tug |
motorman |
12.02.2005 |
26.07.2005 | |
| 2. Grot ug | Dnepro More Product | 400 | Ukraine | Reefer |
3-rd Eng |
03.04.2006 |
03.11.2006 |
| 3. Lydia 1 | MS Mining star Ship | 17500 | Panama | Gen cargo |
motorman |
04.02.2007 |
07.08.2007 |
| 4. Grot ug | Dnepro More Product | 400 | Ukraine | Reefer |
3-rd Eng |
19.09.2007 |
03.12.2007 |
| 5. Lonian Assos | Sigma Marine Ltd | 2500 | Kingstown | Gen cargo |
3-rd Eng |
15.03.2008 |
19.09.2008 |
| 6. Lonian Assos | Sigma Marine Ltd | 2500 | Kingstown | Gen cargo |
3-rd Eng |
26.01.2009 |
08.05.2009 |
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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 |
RD 6T30/50 |
2 |
1200 |
RD/6F |
/1200 |
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| 2. A2 |
SKL 6NVD36 |
4 |
300 |
SKL |
56/300 |
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| 3. A2 |
Man |
4 |
9500 |
Wartsila |
300/9500 |
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| 4. A2 |
SKL 6NVD36 |
4 |
300 |
SKL |
56/300 |
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| 5. A1 |
MAK |
4 |
2000 |
Volvo Penta/TMD 121C |
200/2000 |
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| 6. A1 |
MAK |
4 |
2000 |
Volvo Penta/TMD 121C |
200/2000 |
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| Experience at sea: Since 2005 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||