APPLICATION FORM
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APPLICATION FORM |
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| Name: Andriy | Surname: Kovach | ||||||
| Date of birth: 04.06.1985 | Place of birth: Odessa | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AK 355993 | Place of issue: Odessa | Date of issue: 13.04.2004 | Valid until: 13.04.2014 | ||||
| Seaman’s book: AB 269539 | Place of issue: Odessa | Date of issue: 21.04.2004 | Valid until: 11.01.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Kovach Kateryna | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Odessa Maritime College after Marinesko | Junior Specialist | 2005 | |||||
| Odessa National Maritime Academy | Specialist | 2010 | |||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 01087/2005/08 | Odessa |
05.09.2005 |
--- |
| Endorsement STCW | 01087/2005/08 | Illichivsk |
03.08.2010 |
11.05.2015 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 02556 | Odessa |
11.05.2010 |
11.05.2015 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00247/2005/03 | Illichivsk |
01.07.2005 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00247/2005/03 | Odessa |
02.07.2010 |
12.05.2015 |
| Radar Observation and Plotting (A-II/1,2) | 02106 | Odessa |
11.05.2010 |
11.05.2015 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 02106 | Odessa |
11.05.2010 |
11.05.2015 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 24760 | Odessa |
11.05.2010 |
11.05.2015 |
| Advanced Fire Fighting (A-VI/3) | 01311 | Odessa |
11.05.2010 |
11.05.2015 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 10243 | Odessa |
11.05.2010 |
11.05.2015 |
| Medical First Aid (A-VI/4-1) | 222428 | Odessa |
11.05.2010 |
11.05.2015 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Angela | Redereey Bartels |
9962 |
Ant&Barb |
Container |
Cadet |
27.12.2005 |
24.05.2006 |
| Four Earth | Premuda SPA |
77082 |
Cyprus |
Bulker |
Jun. Off |
31.08.2006 |
18.02.2007 |
| Cap can Diemen | Alpha Ship |
21722 |
MI |
Container |
4-th Off |
28.05.2007 |
27.11.2007 |
| AS Venus | Alpha Ship |
14241 |
MI |
Container |
4-th Off |
15.04.2008 |
22.10.2008 |
| Silver Lakes | Silver Lakes Shipping |
24690 |
Belize |
Bulker |
3-rd Off |
09.12.2008 |
13.06.2009 |
| Lyla | ITS |
180725 |
MI |
Bulker |
3-rd Off |
17.09.2009 |
27.12.2009 |
| Experience at sea: Since 2004 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 06.05.2014 | |||