APPLICATION FORM
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APPLICATION FORM |
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| Name: Sergiy | Surname: Tilipalov | |||
| Date of birth: 02.04.1964 | Place of birth: Ukraine | |||
| Permanent address: Mariupol, Ukraine | ||||
| Passport (OVIR): EK 321989 | Place of issue: Donetsk | Date of issue: 07.2009 | Valid until: 07.2019 | |
| Seaman’s book: AB 423119 | Place of issue: Donetsk | Date of issue: 07.2009 | Valid until: 07.2013 | |
| Citizenship: Ukraine | Expiry date of U.S. visa: 08.2010 | |||
| Marital Status: | Married | |||
| Next of kin: (name, pas. No) | ||||
| Supported children under age of 18 | ||||
| (name, surname, date of birth) | ||||
| Knowledge of English language: | Very good | |||
| Education: | Qualification: | No Diploma: | Date of Issue: | |
| Kherson Nautical College | El. Engineer | . | 1997 | |
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00094/2004/06 | Mariupol |
02.02.2004 |
--- |
| Endorsement STCW | 00094/2004/06 | Mariupol |
02.02.2004 |
05.03.2013 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 103406-AS | Mariupol |
03.2008 |
03.2013 |
| Advanced Fire Fighting (A-VI/3) | 11433-AS | Mariupol |
03.2008 |
03.2013 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 11844-AS | Mariupol |
03.2008 |
03.2013 |
| Medical First Aid (A-VI/4-1) | 10688-AS | Mariupol |
03.2008 |
03.2013 |
|
Tanker Certificates: |
. |
. |
. |
. |
| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 0807-AS | Mariupol |
03.2008 |
03.2013 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) | 0292-AS | Mariupol |
04.2008 |
04.2013 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 1135-AS | Mariupol |
03.2008 |
03.2013 |
Sea service (during five last years):
|
N |
Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. | Mattheus I | Morevest Shipping |
50000 |
Cyprus |
Oil/Ch. Tanker |
El.Engineer |
03.2005 |
07.2005 |
| 2. | Team Actinia | Actinia Shipping |
50000 |
Cyprus |
Oil/Ch. Tanker |
El.Engineer |
10.2005 |
01.2006 |
| 3. | Seatrout | German Tanker |
42000 |
Germany |
Oil/Ch. Tanker |
El.Engineer |
05.2006 |
09.2006 |
| 4. | Sea Devil | German Tanker |
32500 |
Germany |
Oil/Ch. Tanker |
El.Engineer |
10.2006 |
01.2007 |
| 5. | Maratha | Arcadia Shipmanagement |
105000 |
Greece |
VLCC |
El.Engineer |
08.2007 |
02.2008 |
| 6. | Aegean Angel | Arcadia Shipmanagement |
150000 |
Greece |
VLCC |
El.Engineer |
06.2008 |
11.2008 |
| 7. | Aegean Glory | Arcadia Shipmanagement |
50000 |
Liberia |
Oil/Ch. Tanker |
El.Engineer |
01.2009 |
05.2009 |
|
N |
Main Eng. Maker/Model |
Engine Total HP |
Aux.Engine Maker/Number,s |
Aux. Engine H.P. / KW |
Voltage (220/380/440) |
Automation class (A1/A2) |
Automation System Maker |
Crane/Maker/ Type/SWL |
Derrick/Maker/ Type/SWL |
|
1. |
B&W |
10000 |
B&W |
750 |
440 |
A1 |
Lingso |
. |
. |
|
2. |
B&W |
10000 |
B&W |
500 |
440 |
A1 |
Norcontrol |
. |
. |
|
3. |
Man B&W |
12000 |
Wartsila |
750 |
440 |
A1 |
Siemens |
. |
. |
|
4. |
Man B&W |
10200 |
Yanmar |
500 |
440 |
A1 |
Janssen |
. |
. |
|
5. |
Hyundai B&W |
12000 |
Hyundai B&W/3 |
750 |
440 |
A1 |
Hyundai |
. |
. |
|
6. |
Hyundai B&W |
15000 |
Hyundai B&W/3 |
900 |
440 |
A1 |
Norcontrol |
. |
. |
|
7. |
MitsubishiB&W |
10000 |
Yanmar |
500 |
440 |
A1 |
JRC |
. |
. |
| Experience at sea: Since 1997 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 2017 | |||
Ready to work from: any time