APPLICATION FORM
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APPLICATION FORM |
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| Name: Oleksandr | Surname: Andreyev | ||||||
| Date of birth: 18.08.1985 | Place of birth: Odessa | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): EK 424380 | Place of issue: Odessa | Date of issue: 18.08.2009 | Valid until: 18.08.2019 | ||||
| Seaman’s book: AB 262696 | Place of issue: Odessa | Date of issue: 21.03.2003 | Valid until: 16.01.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 03.02.2013 | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | mother - Nina Andreyeva, KE 951763 | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa National Maritime Academy | Navigator | . | 05.03.2008 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00753/2009/08 | Odessa |
06.07.2009 |
--- |
| Endorsement STCW | 00753/2009/08 | Odessa |
06.07.2009 |
15.11.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 88229/2006 | Odessa |
15.11.2006 |
15.11.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00134/2007/03 | Illichivsk |
28.02.2007 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00134/2007/03 | Illichivsk |
28.02.2007 |
15.12.2011 |
| Radar Observation and Plotting (A-II/1,2) | 11133-2009 M/T | Odessa |
05.06.2009 |
05.06.2014 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 11133-2009 M/T | Odessa |
05.06.2009 |
05.06.2014 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 2233/2006 | Odessa |
27.11.2006 |
27.11.2011 |
| Advanced Fire Fighting (A-VI/3) | 44433/2006 | Odessa |
15.11.2006 |
15.11.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 49136/2006 | Odessa |
15.11.2006 |
15.11.2011 |
| Ship's Medical Care (A-VI/4-2) | 20347 M/T | Odessa |
04.06.2009 |
04.06.2014 |
| Ship Safety Officer | 011/2007 | Odessa |
05.02.2007 |
05.02.2012 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 337/06 | Odessa |
05.06.2009 |
05.06.2014 |
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Tanker Certificates: |
. |
. |
. |
. |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 0994/2006 | Odessa |
24.11.2006 |
24.11.2011 |
| Crude oil washing | 0555/2006 | Odessa |
24.11.2006 |
24.11.2011 |
| Inert gas system | 0498/2006 | Odessa |
24.11.2006 |
24.11.2011 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Iron King | Starline |
161000 |
Isle of Man |
Bulk carrier |
Nav. cadet |
22.04.2005 |
23.12.2005 |
| Leeds Castle | B.Navi Shipmanagement |
41880 |
Cayman Isl |
Gen cargo |
3-rd Off |
16.04.2007 |
30.09.2007 |
| York Castle | B.Navi Shipmanagement |
46650 |
Malta |
Gen cargo |
3-rd Off |
12.02.2008 |
07.03.2008 |
| York Castle | B.Navi Shipmanagement |
46650 |
Malta |
Gen cargo |
2-nd Off |
07.03.2008 |
05.09.2008 |
| Docebay | V.Ships |
152308 |
Liberia |
Bulk carrier |
2-nd Off |
20.10.2008 |
25.04.2009 |
| Experience at sea: Since 2005 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 23668 | Issued: 18.10.2008 | Place: Odessa | Exp. date: 18.10.2009 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 12.05.2014 | |||