APPLICATION FORM
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APPLICATION FORM |
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| Name: Mykhaylo | Surname: Gereskul | ||||||
| Date of birth: 20.08.1953 | Place of birth: Odessa | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): EA 766309 | Place of issue: Odessa | Date of issue: 07.04.2008 | Valid until: 07.04.2013 | ||||
| Seaman’s book: AB 369783 | Place of issue: Odessa | Date of issue: 03.03.2008 | Valid until: 03.03.2018 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Gereskul Natalia | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Odessa State Marine Academy | Engineer-Navigator | 06.1991 | |||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 01016/2002/01 | Izmail |
03.10.2002 |
--- |
| Endorsement STCW | 01016/2002/01 | Izmail |
15.03.2006 |
22.02.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 93774/2006 | Odessa |
23.02.2006 |
23.02.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 01083/2003/08 | Odessa |
20.06.2003 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 01083/2003/08 | Izmail |
06.03.2006 |
01.03.2011 |
| Radar Observation and Plotting (A-II/1,2) | 0080/2006 | Odessa |
23.02.2006 |
23.02.2011 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0080/2006 | Odessa |
23.02.2006 |
23.02.2011 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 0356/2006 | Odessa |
22.02.2006 |
22.02.2011 |
| Advanced Fire Fighting (A-VI/3) | 41098/2006 | Odessa |
23.02.2006 |
23.02.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 45288/2006 | Odessa |
22.02.2006 |
22.02.2011 |
| Medical First Aid (A-VI/4-1) | 10019 U | Izmail |
27.02.2006 |
27.02.2011 |
| DP officer certificate | S154/07 | Singapore |
19.04.2007 |
--- |
| Bridge team management | 2607 KS | Kyiv |
11.03.2006 |
11.03.2011 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Delta Reefer | United Power Alliance Ltd |
2830 |
Panama |
Reefer |
Master |
28.06.2003 |
29.03.2004 |
| GAC Canopus | Gulf Agency Co |
360 |
Panama |
Research |
Master |
19.10.2004 |
03.04.2005 |
| GAC Canopus | Gulf Agency Co |
360 |
Panama |
Research |
Master |
28.05.2005 |
17.01.2006 |
| GAC Canopus | Gulf Agency Co |
360 |
Panama |
Research |
Master |
22.03.2006 |
02.09.2006 |
| Grif | Whitesea Shipping & Supply |
1252 |
Ukraine |
AHTS |
Master |
27.06.2007 |
28.12.2007 |
| Experience at sea: Since 1985 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 16.04.2018 | |||