APPLICATION FORM
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APPLICATION FORM |
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| Name: Volodymyr | Surname: Azyoma | ||||||
| Date of birth: 06.09.1957 | Place of birth: Russia | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): EE 772362 | Place of issue: Odessa | Date of issue: 09.12.2008 | Valid until: 09.12.2018 | ||||
| Seaman’s book: AB 083079 | Place of issue: Ilychevsk | Date of issue: 19.09.2002 | Valid until: 19.09.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 31.01.2010 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Azoyma Irene | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Institut of Communication Odessa | Engineer Radio and TV | 1989 | |||||
| Odessa Secondary Marine School | Short Voyage Navigator | 2000 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00125/2010/08 | Odessa |
10.02.2010 |
--- |
| Endorsement STCW | 00125/2010/08 | Odessa |
10.02.2010 |
12.12.2013 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 2036/2009 | Odessa |
08.12.2009 |
08.12.2014 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 02471/2003/08 | Odessa |
29.12.2003 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 02471/2003/08 | Odessa |
06.02.2009 |
12.04.2014 |
| Radar Observation and Plotting (A-II/1,2) | 0577/2008 | Odessa |
12.12.2008 |
12.12.2013 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0577/2008 | Odessa |
12.12.2008 |
12.12.2013 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 1569/2009 | Odessa |
07.12.2009 |
07.12.2014 |
| Advanced Fire Fighting (A-VI/3) | 1037/2009 | Odessa |
09.12.2009 |
09.12.2014 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 4069/2008 | Odessa |
24.12.2008 |
24.12.2013 |
| Ship's Medical Care (A-VI/4-2) | 0630/2009 | Odessa |
11.12.2009 |
11.12.2014 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 1304/2008 | Odessa |
12.12.2008 |
12.12.2013 |
| ECDIS | 0088/2006 | Odessa |
10.03.2006 |
10.03.2011 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Hyundai Commodore | Danaos |
66836 |
Greece |
Cont |
2-nd Off |
14.03.2004 |
16.09.2004 |
| Henry | Danaos |
53280 |
Greece |
Cont |
2-nd Off |
04.04.2005 |
26.11.2005 |
| Victory I | Danaos |
54809 |
Panama |
Cont |
2-nd Off |
15.04.2006 |
19.11.2006 |
| CMA CGM Lotus | Danaos |
54809 |
Panama |
Cont |
2-nd Off |
27.04.2007 |
10.12.2007 |
| Hyundai Vladivostok | Danaos |
33611 |
Panama |
Cont |
2-nd Off |
11.04.2008 |
21.08.2008 |
| Arcangelo | Spianada |
30520 |
Marshall isl. |
Cont |
2-nd Off |
27.02.2009 |
09.05.2009 |
| Experience at sea: Since 1980 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 014880 | Issued: 27.02.2009 | Place: Odessa | Exp. date: 26.02.2010 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 23.02.2015 | |||