APPLICATION FORM
|
|
APPLICATION FORM |
|
| Name: Sergey | Surname: Dyvashchenko | ||||||
| Date of birth: 05.05.1973 | Place of birth: Odessa | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): PO 318339 | Place of issue: Odessa | Date of issue: 07.09.2006 | Valid until: 07.09.2016 | ||||
| Seaman’s book: AB 408590 | Place of issue: Ilychevsk | Date of issue: 12.01.2009 | Valid until: 12.01.2014 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 18.10.2010 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Divashchenko Lyubov | ||||||
| Supported children under age of 18 | 1. Divashchenko Elena | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa High School | Cook | . | 01.09.1990 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00763/2004/03 |
Ilychevsk |
20.08.2004 |
--- |
| Endorsement STCW |
00763/2004/03 |
Ilychevsk |
18.03.2009 |
14.09.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
LZ 12838B |
Odessa |
14.09.2006 |
14.09.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
LZ 52311B |
Odessa |
06.12.2004 |
06.12.2009 |
| Ro-Ro Passenger ships (A-V/2) |
LZ 05578B |
Odessa |
06.12.2004 |
06.12.2009 |
|
Tanker Certificates |
|
|
|
|
| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) |
8644 KS |
Kyiv |
04.11.2005 |
04.11.2010 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) |
8644 KS |
Kyiv |
04.11.2005 |
04.11.2010 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) |
8644 KS |
Kyiv |
04.11.2005 |
04.11.2010 |
| Crude oil washing |
3375 KS |
Kyiv |
04.11.2005 |
04.11.2010 |
| Inert gas system |
1461 KS |
Kyiv |
04.11.2005 |
04.11.2010 |
Sea service (during five last years):
|
Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| Merito | Admiral Shipping |
. |
Ant&Barb |
Container |
Cook |
01.2005 |
07.2005 |
| Four Bay | Premuda SPA |
. |
Italy |
Tanker |
Cook |
11.2005 |
08.2006 |
| Wesertor | Phoenix Reederey |
. |
Madeira |
Container |
Cook |
09.2006 |
03.2007 |
| War Admiral | Tidewater |
. |
USA |
WSS (DP1) |
Cook |
09.2007 |
12.2007 |
| Hyundai Sprinter | Danaos |
. |
Panama |
Container |
Cook |
03.2008 |
12.2008 |
| Experience at sea: Since 1995 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ 27843 | Issued: 20.03.2009 | Place: Odessa | Exp.date: 20.03.2010 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||
Ready to work from: any time