APPLICATION FORM
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APPLICATION FORM |
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| Name: Andriy | Surname: Pyhar | ||||||
| Date of birth: 13.07.1983 | Place of birth: Russia | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): AK 037958 | Place of issue: Kherson | Date of issue: 15.01.2004 | Valid until: 15.01.2014 | ||||
| Seaman’s book: AB 183065 | Place of issue: Kherson | Date of issue: 19.11.2001 | Valid until: 14.08.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | mother - Pyhar Alla, MO 625364 | ||||||
| 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: | ||||
| Kherson Marine College | 3-rd Engineer | - | - | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00880/2003/07 | Nikolaev |
11.07.2003 |
--- |
| Endorsement STCW | 00880/2003/07 | Nikolaev |
11.07.2003 |
18.04.2008 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 0855/03KH | Odessa |
18.04.2003 |
18.04.2008 |
| Advanced Fire Fighting (A-VI/3) | 0984/03KH | Odessa |
18.04.2003 |
18.04.2008 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 1233/03KH | Odessa |
18.04.2003 |
18.04.2008 |
| Medical First Aid (A-VI/4-1) | 0676/03KH | Odessa |
18.04.2003 |
18.04.2008 |
| Ro-Ro Passenger ships (A-V/2) | 7275 E | Odessa |
28.10.2005 |
28.10.2010 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Irida | Budier Co. LTD | 7000 | Malta | Dry Cargo |
4-th Eng |
22.09.2003 |
02.11.2003 |
| 2. Delta | Budier Co. LTD | 3500 | Georgia | Dry Cargo |
3-rd Eng |
02.11.2003 |
01.05.2004 |
| 3. Delta | Budier Co. LTD | 3500 | Georgia | Dry Cargo |
3-rd Eng |
19.05.2004 |
19.11.2005 |
| 4. Superfast X | Superfast Deca | 30285 | Greece | pass/Ro-Ro |
wiper |
17.11.2005 |
05.06.2006 |
| 5. Jolly | Colby Trading LTD | 29693 | Marshall Isl | cont |
oiler |
01.11.2006 |
29.04.2007 |
|
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 |
Duece |
4 |
3000 |
. |
. |
. |
. |
| 2. A2 |
Skoda |
4 |
1500 |
. |
. |
. |
. |
| 3. A2 |
Skoda |
4 |
1500 |
. |
. |
. |
. |
| 4. A1 |
Sulzer/Wartsilla |
4 |
4x15560 |
MAN B&W/3 |
. |
. |
. |
| 5. A1 |
MAN B&W |
2 |
18023 |
MAN B&W/2 |
. |
. |
. |
| Experience at sea: Since 2003 | Knowledge Personal Computer (Yes / No): yes | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 12.10.2015 | |||
Ready to work from: 10.2007