APPLICATION FORM
|
APPLICATION FORM |
|
| Name: Volodymyr | Surname: Burnashov | ||||||
| Date of birth: 12.05.1979 | Place of birth: Odessa | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AT 685317 | Place of issue: Odessa | Date of issue: 23.04.2001 | Valid until: 23.04.2011 | ||||
| Seaman’s book: AB 341780 | Place of issue: Odessa | Date of issue: 12.09.2006 | Valid until: 12.09.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 05.09.2010 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Burnashova Olga | ||||||
| Supported children under age of 18 | 1. Vladyslav Burnashov, 19.04.2006 | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Very good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa NAtional Maritime Academy | Navigator | . | 05.03.2002 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00330/2008/03 | Illichivsk |
29.04.2008 |
--- |
| Endorsement STCW | 00330/2008/03 | Illichivsk |
29.04.2008 |
26.02.2013 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 0695/2008 | Odessa |
28.02.2008 |
28.02.2013 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 01895/2003/08 | Odessa |
26.09.2003 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 01895/2003/08 | Odessa |
29.04.2008 |
01.04.2013 |
| Radar Observation and Plotting (A-II/1,2) | 0102/2008 | Odessa |
29.02.2008 |
01.03.2013 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0102/2008 | Odessa |
29.02.2008 |
01.03.2013 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 0215/2008 | Odessa |
27.02.2008 |
27.02.2013 |
| Advanced Fire Fighting (A-VI/3) | 0352/2008 | Odessa |
27.02.2008 |
27.02.2013 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 0556/2008 | Odessa |
26.02.2008 |
26.02.2013 |
| Ship's Medical Care (A-VI/4-2) | 0127/2008 | Odessa |
27.02.2008 |
27.02.2013 |
| Cyprus Seaman's book | CY 088223 | Limassol |
10.11.2005 |
09.11.2015 |
| Cyprus Endorsement | RE 00361508 | Limassol |
21.05.2008 |
26.02.2013 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Nena C | Acomarin |
43188 |
Panama |
Bulk carrier |
3-rd Off |
02.10.2004 |
28.05.2005 |
| Nena F | Acomarin |
42263 |
Cyprus |
Bulk carrier |
3-rd Off |
01.11.2005 |
04.06.2006 |
| Nena M | Corason del Mar |
43171 |
Liberia |
Bulk carrier |
3-rd Off |
05.11.2006 |
16.02.2007 |
| Nena M | Corason del Mar |
43171 |
Liberia |
Bulk carrier |
2-nd Off |
16.02.2007 |
01.04.207 |
| Mary G | Corason del Mar |
43877 |
Liberia |
Bulk carrier |
2-nd Off |
19.06.2007 |
15.02.2008 |
| Almi | Corason del Mar |
42263 |
Cyprus |
Bulk carrier |
2-nd Off |
15.05.2008 |
27.09.2008 |
| 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: 06.09.2012 | |||