APPLICATION FORM
|
|
APPLICATION FORM |
|
| Name: Sergiy | Surname: Vorst | ||||||
| Date of birth: 13.02.1975 | Place of birth: Kerch, Ukraine | ||||||
| Permanent address: Kerch, Ukraine | |||||||
| Passport (OVIR): AM 002141 | Place of issue: Kerch | Date of issue: 01.11.2001 | Valid until: 01.11.2011 | ||||
| Seaman’s book: AB 256800 | Place of issue: Kerch | Date of issue: 28.07.2005 | Valid until: 28.07.2010 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 08.02.2012 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Yana Vorst | ||||||
| Supported children under age of 18 | 1. Ivan Vorst, 07.03.1997 | ||||||
| (name, surname, date of birth) | 2. Katerina Vorst, 30.07.2006 | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa Marine School of fish industry | 3-rd Engineer | . | 15.07.2009 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00072/2009/05 | Kerch |
15.07.2009 |
--- |
| Endorsement STCW | 00072/2009/05 | Kerch |
15.07.2009 |
17.04.2014 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 3/098/09 | Odessa |
17.04.2009 |
17.04.2014 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 3/018/09 | Odessa |
15.04.2009 |
15.04.2014 |
| Advanced Fire Fighting (A-VI/3) | 3/015/09 | Odessa |
20.04.2009 |
20.04.2014 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 3/031/09 | Odessa |
20.04.2009 |
20.04.2014 |
| Medical First Aid (A-VI/4-1) | 3/012/09 | Odessa |
17.04.2009 |
17.04.2014 |
| Ro-Ro Passenger ships (A-V/2) | 3/014/09 | Odessa |
20.04.2009 |
20.04.2014 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Alda | Doriam Navigation Co Ltd | 22076 | Valletta | Bulker |
motorman-turner |
07.08.2004 |
30.05.2005 |
| 2. Alinda | Titan Maritime Company Ltd | 17855 | Valletta | Bulker |
motorman-turner |
12.01.2006 |
30.08.2006 |
| 3. CMA CGM Lotus | Danaos | 42809 | Panama | Container |
oiler |
14.02.2007 |
12.10.2007 |
| 4. MSC Nikita | MSC | 36849 | Panama | Container |
motorman |
10.11.2007 |
29.05.2008 |
| 5. MSC Nilgun | MSC | 30971 | Panama | Container |
motorman |
22.09.2008 |
14.03.2009 |
|
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. A1 |
Sulzer |
2 |
11000 |
Daihatsu |
/ |
. |
. |
| 2. A1 |
B&W |
2 |
13100 |
Daihatsu |
/ |
. |
. |
| 3. A1 |
Mitsui B&W 9l80mc |
2 |
37890 |
Daihatsu |
/ |
. |
. |
| 4. A1 |
Mitsubishi-Sulzer |
2 |
30150 |
Daihatsu |
/ |
. |
. |
| 5. A1 |
Man B&W 7l70mc |
2 |
26740 |
Man B&W |
/ |
. |
. |
| Experience at sea: Since 1997 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 06.06.2013 | |||
Ready to work from: any time