APPLICATION FORM
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APPLICATION FORM |
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| Name: Roman | Surname: Nechay | ||||||
| Date of birth: 27.09.1977 | Place of birth: Ukraine | ||||||
| Permanent address: Kiev, Ukraine | |||||||
| Passport (OVIR): AM 475459 | Place of issue: Kiev | Date of issue: 15.06.2000 | Valid until: 15.06.2010 | ||||
| Seaman’s book: AB 351144 | Place of issue: Kherson | Date of issue: 23.01.2006 | Valid until: 23.01.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 11.01.2010 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | mother - Nechay Nina | ||||||
| Supported children under age of 18 | no | ||||||
| (name, surname, date of birth) | no | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa National Maritime Academy | 3-rd Eng | . | 03.03.2003 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 01193/2003/08 | Odessa |
14.04.2003 |
--- |
| Endorsement STCW | 01193/2003/08 | Kiev |
18.06.2008 |
18.06.2013 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 102721 KS | Kiev |
07.06.2008 |
07.06.2013 |
| Advanced Fire Fighting (A-VI/3) | 12167 KS | Kiev |
07.06.2008 |
07.06.2013 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 11516 KS | Kiev |
07.06.2008 |
07.06.2013 |
| Medical First Aid (A-VI/4-1) | 10599 KS | Kiev |
07.06.2008 |
07.06.2013 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Vienna Wood | Four ringsShipping Co ltd | 17824 | Slovakia | Bulker |
oiler |
17.06.2003 |
30.12.2003 |
| 2. Sotiria | Larus S.A. | 13677 | Malta | Bulker |
oiler |
21.01.2004 |
02.10.2004 |
| 3. Pervorechensk | UK Service | 3000 | Russia | MFBR |
3-rd Eng |
27.03.2005 |
25.12.2005 |
| 4. Grain Trader | Sword Trading S.A. | 18322 | Panama | Bulker |
oiler |
12.06.2006 |
22.08.2006 |
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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 |
MAN B&W |
2 |
11200 |
Daihatsu |
11200/8355 |
No |
Yes |
| 2. A2 |
Pilstik |
4 |
8000 |
. |
8000/5968 |
No |
Yes |
| 3. A2 |
SCL |
4 |
850 |
. |
850/634 |
No |
Yes |
| 4. A2 |
Split MAN |
2 |
10340 |
. |
10340/7713 |
No |
Yes |
| Experience at sea: Since 2001 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||
Ready to work from: any time