APPLICATION FORM
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APPLICATION FORM |
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| Name: Volodymyr | Surname: Brovchenko | ||||||
| Date of birth: 03.04.1969 | Place of birth: Sevastopol | ||||||
| Permanent address: Mariupol, Ukraine | |||||||
| Passport (OVIR): AK 035826 | Place of issue: Kherson | Date of issue: 25.11.2003 | Valid until: 25.11.2013 | ||||
| Seaman’s book: AB 255688 | Place of issue: Mariupol | Date of issue: 27.11.2003 | Valid until: 25.09.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 22.09.2010 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Emma Brovchenko | ||||||
| Supported children under age of 18 | Anastasia Brovchenko, 04.09.1995 | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kherson Marine College | Navigator | 02.08.1988 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00071/2008/06 | Mariupol |
18.03.2008 |
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| Endorsement STCW | 00071/2008/06 | Mariupol |
18.03.2008 |
27.10.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 20208-AS | Mariupol |
16.01.2007 |
16.01.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00060/2003/09 | Sevastopol |
19.02.2003 |
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| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00060/2003/09 | Mariupol |
14.11.2006 |
03.11.2011 |
| Radar Observation and Plotting (A-II/1,2) | 0682 KC | Mariupol |
03.11.2006 |
03.11.2011 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0682 KC | Mariupol |
03.11.2006 |
03.11.2011 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 03160 KC | Mariupol |
31.10.2006 |
31.10.2011 |
| Advanced Fire Fighting (A-VI/3) | 07929-AS | Mariupol |
15.01.2007 |
15.01.2012 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 11110-AS | Mariupol |
10.01.2007 |
10.01.2012 |
| Ship's Medical Care (A-VI/4-2) | 1468 KC | Mariupol |
27.10.2006 |
27.10.2011 |
| The operational use of ECDIS | 0168 KC | Mariupol |
04.10.2005 |
04.10.2010 |
| Refresher and updating courses (II/1) | 304678 | Mariupol |
14.11.2006 |
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| Risk assessment course (ISM Code) | 304678 | Mariupol |
01.04.2008 |
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| Large Ship's Handling | 0003/08-AS | Mariupol |
02.04.2008 |
02.04.2013 |
| Ship Handling Arrangements | 0304-AS | Mariupol |
08.11.2006 |
08.11.2011 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 000840/2009/03 | Mariupol |
27.07.2009 |
27.07.2014 |
| Bridge Team & Resources Management | 0281-AS | Mariupol |
04.04.2008 |
04.04.2013 |
| SMS Shipping company's Internal Auditor | K.0898.32 | Mariupol |
04.04.2008 |
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Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Puma | Lomar |
33140 |
Bahamas |
Bulk carrier |
Ch. Off |
19.12.2005 |
18.09.2006 |
| Maistros Breeze | Interunity |
29078 |
Hong Kong |
Bulk carrier |
Ch. Off |
07.04.2007 |
03.11.2007 |
| Pioneer Epos | Interunity |
75470 |
Hong Kong |
Bulk carrier |
Ch. Off |
04.04.2008 |
28.07.2008 |
| Ma Cho | Fenwick |
16680 |
Hong Kong |
Bulk carrier |
Ch. Off |
02.01.2009 |
29.05.2009 |
| Tien Hau | Fenwick |
18306 |
Hong Kong |
Gen cargo |
Ch. Off |
07.08.2009 |
05.02.2010 |
| Experience at sea: Since 1991 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccinationfor cholera valid until: | Vaccination for yellow fever valid until: 26.11.2013 | |||