APPLICATION FORM
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APPLICATION FORM |
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| Name: Petro | Surname: Chevela | ||||||
| Date of birth: 23.04.1948 | Place of birth: Donetsk reg. | ||||||
| Permanent address: Mariupol, Ukraine | |||||||
| Passport (OVIR): EE 240466 | Place of issue: Mariupol | Date of issue: 04.06.2008 | Valid until: 04.08.2018 | ||||
| Seaman’s book: AB 282901 | Place of issue: Mariupol | Date of issue: 09.01.2006 | Valid until: 09.01.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Elena Chevela | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Rostov-on-Don Marine College | Voyages Engineer-Navigator | 1975 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00422/2002/06 | Mariupol |
11.09.2002 |
--- |
| Endorsement STCW | 00422/2002/06 | Mariupol |
23.06.2008 |
04.08.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 12518-AS | Mariupol |
15.08.2006 |
15.08.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00504/2003/06 | Mariupol |
29.09.2003 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00504/2003/06 | Mariupol |
19.06.2008 |
06.06.2013 |
| Radar Observation and Plotting (A-II/1,2) | 10546-AS | Mariupol |
30.05.2008 |
30.05.2013 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 10546-AS | Mariupol |
30.05.2008 |
30.05.2013 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 03026-AS | Mariupol |
04.08.2006 |
04.08.2011 |
| Advanced Fire Fighting (A-VI/3) | 05369-AS | Mariupol |
14.08.2006 |
14.08.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 06623-AS | Mariupol |
09.08.2006 |
09.08.2011 |
| Ship's Medical Care (A-VI/4-2) | 1227-AS | Mariupol |
18.08.2006 |
18.08.2011 |
| Ship Handling Arragements | 10478-AS | Mariupol |
28.05.2008 |
28.05.2013 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 000836/2009/03 | Mariupol |
27.07.2009 |
27.07.2014 |
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Tanker Certificates: |
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|
|
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 20668 KC | Mariupol |
26.03.2010 |
26.03.2015 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 1148-AS | Mariupol |
12.06.2008 |
12.06.2013 |
| Crude oil washing | 1148-AS | Mariupol |
12.06.2008 |
12.06.2013 |
| Inert gas system | 1148-AS | Mariupol |
12.06.2008 |
12.06.2013 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Bella III | Fernada Ent |
25712 |
Panama |
Bulker |
Master |
03.07.2005 |
21.12.005 |
| Gracia | Priamos Ltd |
24198 |
Malta |
Bulker |
Master |
09.01.2006 |
25.07.2006 |
| Gronx | Gronx Ltd SA |
14982 |
Dominica |
Bulker |
Master |
27.10.2006 |
12.06.2007 |
| Gronx | Gronx Ltd SA |
14982 |
Dominica |
Bulker |
Master |
07.08.2007 |
25.05.2008 |
| Gronx | Gronx Ltd SA |
14982 |
Dominica |
Bulker |
Master |
12.09.2008 |
12.06.2009 |
| Marianao Ice | Parships AS |
6232 |
Dominica |
Reefer |
08.03.2010 |
05.05.2010 |
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| Experience at sea: 1966 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 580 | Issued: 28.04.2010 | Place: Mariupol | Exp. date: 28.04.2011 |
| Vaccinationfor cholera valid until: | Vaccination for yellow fever valid until: 30.08.2019 | |||