APPLICATION FORM
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APPLICATION FORM |
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| Name: Aleksandr | Surname: Kulyk | ||||||
| Date of birth: 11.04.1987 | Place of birth: Kherson | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): PO 366830 | Place of issue: Kherson | Date of issue: 29.05.2006 | Valid until: 29.05.2016 | ||||
| Seaman’s book: AB 328094 | Place of issue: Kherson | Date of issue: 03.10.2005 | Valid until: 03.10.2010 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | mother - Kulyk Larisa, MO 650016 | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kherson maritime liceum | AB | 30.06.2005 | |||||
| Kherson Maritime College | Navigation | 29.06.2009 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 01070/2009/11 | Kherson |
29.06.2009 |
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| Endorsement STCW | 01070/2009/11 | Kherson |
29.06.2009 |
09.09.2014 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 11709/2009/42/01 | Nikolaev |
09.09.2009 |
09.09.2014 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00321/2009/07 | Nikolaev |
27.10.2009 |
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| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00321/2009/07 | Nikolaev |
27.10.2009 |
27.10.2014 |
| Radar Observation and Plotting (A-II/1,2) | 00780/2009/42/30 | Nikolaev |
09.09.2009 |
09.09.2014 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 00780/2009/42/30 | Nikolaev |
09.09.2009 |
09.09.2014 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 07286/2009/42/20 | Nikolaev |
09.09.2009 |
09.09.2014 |
| Advanced Fire Fighting (A-VI/3) | 05318/2009/42/04 | Nikolaev |
09.09.2009 |
09.09.2014 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 09756/2009/42/02 | Nikolaev |
09.09.2009 |
09.09.2014 |
| Medical First Aid (A-VI/4-1) | 03399/2009/42/05 | Nikolaev |
09.09.2009 |
09.09.2014 |
| Belgium Seaman's book | 090090 | Belgium |
24.01.2008 |
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Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Twin | Azimut |
3174 |
Cambodia |
Dry cargo |
AB |
14.06.2006 |
19.10.2006 |
| Danadi 1 | Azimut |
6207 |
Malta |
Bulker |
AB |
24.04.2007 |
13.10.2007 |
| Atlantic Express | Univis |
25000 |
Belgium |
Multipurp |
OS |
04.02.2008 |
28.08.2008 |
| Suez Express | Univis |
25000 |
Belgium |
Multipurp |
OS |
04.12.2008 |
07.05.2009 |
| Donbas Voyager | Metal Invest |
3000 |
Ukraine |
Gen cargo |
3-rd Off |
12.2009 |
03.2010 |
| Experience at sea: Since 2006 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 021413 | Issued: 24.12.2009 | Place: Kherson | Exp. date: 24.12.2010 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 01.06.2016 | |||