APPLICATION FORM
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APPLICATION FORM |
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| Name: Ihor | Surname: Bezkopyl'nyi | ||||||
| Date of birth: 11.04.1983 | Place of birth: Nikolaev | ||||||
| Permanent address: Nikolaev, Ukraine | |||||||
| Passport (OVIR): AK 774126 | Place of issue: Kherson | Date of issue: 31.03.2005 | Valid until: 31.03.2015 | ||||
| Seaman’s book: AB 358717 | Place of issue: Nikolaev | Date of issue: 22.08.2008 | Valid until: 06.08.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | |||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kherson Marine College | Bachelor-navigator | 06.07.2004 | |||||
| Kherson Marine Institute | Specialist-navigator | 25.03.2006 | |||||
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 01303/2008/07 | Nikolaev | 17.09.2008 |
-- |
| Endorsement STCW | 01303/2008/07 | Nikolaev | 17.09.2008 |
13.08.2013 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 07232/2008/42/01 | Nikolaev |
13.08.2008 |
13.08.2013 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00317/2004/07 | Nikolaev |
22.04.2004 |
-- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00317/2004/07 | Nikolaev |
03.09.2008 |
02.09.2013 |
| Radar Observation and Plotting (A-II/1,2) | 00884/2008/42/31 | Nikolaev |
13.08.2008 |
13.08.2013 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 00884/2008/42/31 | Nikolaev |
13.08.2008 |
13.08.2013 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 03904/2008/42/20 | Nikolaev |
13.08.2008 |
13.08.2013 |
| Advanced Fire Fighting (A-VI/3) | 03320/2008/42/04 | Nikolaev |
13.08.2008 |
13.08.2013 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 05818/2008/42/02 | Nikolaev |
13.08.2008 |
13.08.2013 |
| Medical First Aid (A-VI/4-1) | 00905/2008/42/06 | Nikolaev |
13.08.2008 |
13.08.2013 |
| Ship's Medical Care(A-V/2) | 00905/2008/42/06 | Nikolaev |
13.08.2008 |
13.08.2013 |
| Ship Handling Arrangements (management level) | 00956/2008/42/60 | Nikolaev |
13.08.2008 |
13.08.2013 |
| Ship Safety Officer | 00221/2007/42/44 | Nikolaev |
12.09.2007 |
12.09.2012 |
| Liberia Seaman's book | 0771278 | Virginia |
05.02.2007 |
05.02.2012 |
| Liberia Endorsement | 793236 | Liberia |
05.02.2007 |
05.02.2012 |
| Panama Seaman's book | 866292 | Panama |
17.02.2009 |
13.08.2013 |
| Panama Endorsement | 12G0407051 | Panama |
19.02.2009 |
13.08.2013 |
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Tanker Certificates |
. |
. |
. |
. |
| Oil Tanker Specialized training | 00550/2008/42/11 | Nikolaev |
13.08.2008 |
13.08.2013 |
Sea Service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Aras 7 | Galbo Alliance Ltd |
3820 |
Georgia |
Dry Cargo |
2-nd Off |
07.05.2006 |
24.10.2006 |
| Taganroga | LatTank |
4999 |
Liberia |
Tanker |
3-rd Off |
25.01.2007 |
28.07.2007 |
| Razna | LatTank |
25191 |
Liberia |
Oil Tanker |
2-nd Off |
25.12.2007 |
26.06.2008 |
| Narcea | Ership |
6771 |
Portugal |
Ch./Oil Tanker |
2-nd Off |
23.01.2009 |
25.04.2009 |
| MGARR | Salvu Zammit |
2400 |
Malta |
Oil tanker |
Ch. Off |
21.09.2009 |
08.02.2010 |
| Experience at sea: Since 2002 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 23.01.2017 | |||