APPLICATION FORM
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APPLICATION FORM |
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| Name: Valeriy | Surname: Kundobin | ||||||
| Date of birth: 02.05.1957 | Place of birth: Simferopol | ||||||
| Permanent address: Izmail, Odessa reg., Ukraine | |||||||
| Passport (OVIR): EC 728144 | Place of issue: Odessa | Date of issue: 12.09.2006 | Valid until: 12.09.2016 | ||||
| Seaman’s book: AB 300367 | Place of issue: Ilyichevsk | Date of issue: 06.09.2006 | Valid until: 06.09.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Kundobina Olga | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Odessa Maritime Tech School | Deep Sea Navigator | 22.06.1999 | |||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 01023/2003/01 | Izmail |
16.04.2003 |
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| Endorsement STCW | 01023/2003/01 | Izmail |
22.04.2008 |
12.03.2013 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 20131/MPS | Kherson |
14.03.2008 |
14.03.2013 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00200/2003/01 | Izmail |
24.03.2003 |
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| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00200/2003/01 | Izmail |
24.03.2008 |
12.03.2013 |
| Radar Observation and Plotting (A-II/1,2) | 0849/MPS | Kherson |
14.03.2008 |
14.03.2013 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0849/MPS | Kherson |
14.03.2008 |
14.03.2013 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 10793/MPS | Kherson |
14.03.2008 |
14.03.2013 |
| Advanced Fire Fighting (A-VI/3) | 07874/MPS | Kherson |
14.03.2008 |
14.03.2013 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 12949/MPS | Kherson |
14.03.2008 |
14.03.2013 |
| Ship's Medical Care (A-VI/4-2) | 0207/MPS | Kherson |
14.03.2008 |
14.03.2013 |
| Cyprus Seaman's book | CY 044174 | Lemesos |
03.07.2003 |
03.07.2013 |
| Cyprus Endorsement | RE 00194309 | Cyprus |
20.03.2009 |
12.03.2013 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Delfa | Meadway |
53622 |
MI |
Bulker |
2-nd Off |
28.09.2005 |
22.07.2006 |
| Dimitra | Petrobulk |
41499 |
Bahamas |
Bulker |
2-nd Off |
01.12.2006 |
28.04.2007 |
| Aristides N. P. | Eurobulk |
69268 |
MI |
Bulker |
2-nd Off |
07.06.2007 |
29.01.2008 |
| Delvina | Meadway |
53622 |
MI |
Bulker |
Ch. Off |
07.07.2008 |
21.08.2008 |
| Turnberry Glory | Oceanfleet |
68308 |
Cyprus |
Bulker |
2-nd Off |
15.05.2009 |
11.11.2009 |
| Experience at sea: Since 1978 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 0791 | Issued: 31.03.2010 | Place: Izmail | Exp. date: 31.03.2011 |
| Vaccinationfor cholera valid until: | Vaccination for yellow fever valid until: 01.06.2017 | |||