APPLICATION FORM
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APPLICATION FORM |
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| Name: Oleksandr | Surname: Lokshyn | ||||||
| Date of birth: 21.08.1982 | Place of birth: Ukraine | ||||||
| Permanent address: Sevastopol, Ukraine | |||||||
| Passport (OVIR): EE 066562 | Place of issue: Sevastopol | Date of issue: 26.05.2008 | Valid until: 26.05.2018 | ||||
| Seaman’s book: AB 390001 | Place of issue: Sevastopol | Date of issue: 20.05.2008 | Valid until: 19.05.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | mother - Lokshyna Olga | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Fair | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Sevastopol Naval Maritime University | Navigator | . | 3rd course | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00139/2009/07 | Nikolaev |
16.02.2009 |
--- |
| Endorsement STCW | 00139/2009/07 | Nikolaev |
16.02.2009 |
18.12.2013 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 06293/2008/25/01 | Sevastopol |
18.12.2008 |
18.12.2013 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 06294/2008/25/02 | Sevastopol |
18.12.2008 |
18.12.2013 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| King Klip | Moreton Ltd |
4407 |
Mauritania |
BAT |
AB |
23.06.2008 |
25.11.2008 |
| Experience at sea: Since 2008 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 17388 | Issued: 21.05.2008 | Place: Sevastopol | Exp. date: 21.05.2009 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 22.05.2018 | |||