APPLICATION FORM
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APPLICATION FORM |
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| Name: Andriy | Surname: Balabko | ||||||
| Date of birth: 19.08.1984 | Place of birth: Odessa reg. Ukraine | ||||||
| Permanent address: Vinogradnoe, Odessa reg, Ukraine | |||||||
| Passport (OVIR): AX 601558 | Place of issue: Odessa | Date of issue: 07.06.2003 | Valid until: 07.06.2013 | ||||
| Seaman’s book: AB 259813 | Place of issue: Odessa | Date of issue: 16.12.2002 | Valid until: 12.02.2012 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | father - Balabko Vasiliy | ||||||
| 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 Marine Academy | Navigator | . | 29.02.2008 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 01804 | Odessa |
15.12.2006 |
--- |
| Endorsement STCW | 01804 | Odessa |
15.12.2006 |
15.12.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 87393 | Odessa |
03.10.2006 |
03.10.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00628 | Illichivsk |
25.12.2006 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00628 | Illichivsk |
25.12.2006 |
25.12.2011 |
| Radar Observation and Plotting (A-II/1,2) | 0377 | Odessa |
20.10.2006 |
21.07.2010 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0377 | Odessa |
20.10.2006 |
21.07.2010 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 1935 | Odessa |
09.10.2006 |
09.10.2011 |
| Advanced Fire Fighting (A-VI/3) | 43912 | Odessa |
03.10.2006 |
03.10.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 48590 | Odessa |
04.10.2006 |
04.10.2011 |
| Medical First Aid (A-VI/4-1) | 32187 | Odessa |
04.10.2006 |
04.10.2011 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Rainbow-II | Ukrcomflot |
2111 |
Cambodia |
Dry cargo |
AB |
28.08.2004 |
27.03.2005 |
| Arabella | Ukrcrewing |
14877 |
Malta |
Bulker |
AB |
24.09.2005 |
04.07.2006 |
| Alexia | Ukrcrewing |
22076 |
Malta |
Bulker |
AB |
28.02.2007 |
24.10.2007 |
| Alexia | Ukrcrewing |
22076 |
Malta |
Bulker |
3-rd Off |
15.05.2008 |
05.12.2008 |
| Barents Strait | Univis |
23840 |
Liberia |
Container |
3-rd Off |
17.04.2009 |
02.09.2009 |
| Experience at sea: Since 2004 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 15.07.2014 | |||