APPLICATION FORM
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APPLICATION FORM |
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| Name: Igor | Surname: Lyubeshkin | ||||||
| Date of birth: 29.05.1978 | Place of birth: Mariupol | ||||||
| Permanent address: Mariupol, Ukraine | |||||||
| Passport (OVIR): KC 622873 | Place of issue: Ukraine | Date of issue: 13.01.2009 | Valid until: 13.01.2019 | ||||
| Seaman’s book: AB 323067 | Place of issue: Ukraine | Date of issue: 09.11.2006 | Valid until: 09.11.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 10.04.2011 | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | mother - Goltvenko Lyubov | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Rostov on Don Marine College | Navigator | 24.06.2005 | |||||
| Odessa National Marine Academy | Navigator | in progress | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 2020302938 | Taganrog |
24.06.2005 |
--- |
| Endorsement STCW | 2020302938 | Taganrog |
24.06.2005 |
24.06.2010 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 048226 | Rostov on Don |
16.05.2005 |
16.05.2010 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00172/2009/06 | Mariupol |
09.09.2009 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00172/2009/06 | Mariupol |
09.09.2009 |
09.09.2014 |
| Radar Observation and Plotting (A-II/1,2) | 0050590 | Taganrog |
02.06.2005 |
--- |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0050590 | Taganrog |
02.06.2005 |
--- |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 011023-AS | Mariupol |
16.01.2004 |
16.01.2009 |
| Advanced Fire Fighting (A-VI/3) | 016056 | Rostov on Don |
06.04.2005 |
06.04.2010 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 028093 | Rostov on Don |
15.04.2005 |
15.04.2010 |
| Medical First Aid (A-VI/4-1) | 018204 | Rostov on Don |
12.04.2005 |
12.04.2010 |
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Tanker Certificates: |
. |
. |
. |
. |
| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 054564 | Rostov on Don |
16.03.2006 |
16.03.2011 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) | 058187 | Rostov on Don |
10.03.2006 |
10.03.2011 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 054352 | Rostov on Don |
06.03.2006 |
06.03.2011 |
| Bridge team & resources management | 0019 KS | Kyiv |
25.03.2006 |
25.03.2011 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Baltic Commander | Interorient Nav. |
23240 |
Cyprus |
Ch. Tanker |
AB |
01.07.2005 |
16.02.2006 |
| Baltic Ambassador | Interorient Nav. |
23240 |
Cyprus |
Ch. Tanker |
3-rd Off |
06.04.2006 |
15.09.2006 |
| Prosperity 1 | Harmony Nav. |
12360 |
Liberia |
Ch. Tanker |
3-rd Off |
30.04.2007 |
27.05.2007 |
| Havi Express | Harmny Nav. |
12360 |
Liberia |
Ch. Tanker |
2-nd Off |
27.05.2007 |
30.09.2007 |
| Ievoli Shine | Marnavi S.P.A |
9500 |
Italy |
Ch. Tanker |
2-nd Off |
03.12.2007 |
05.03.2008 |
| Ievoli Star | Marnavi S.P.A |
6500 |
Italy |
Ch. Tanker |
2-nd Off |
11.03.2008 |
20.04.2008 |
| Gennaro Ievoli | Marnavi S.P.A |
27912 |
Italy |
Ch. Tanker |
2-nd Off |
08.07.2008 |
19.09.2008 |
| Luca Ievoli | Marnavi S.P.A |
5207 |
Italy |
Ch. Tanker |
2-nd Off |
03.09.2008 |
21.12.2008 |
| Rita | Marnavi S.P.A |
9000 |
Italy |
Ch. Tanker |
2-nd Off |
04.03.2009 |
22.07.2009 |
| Luca Ievoli | Marnavi S.P.A. |
5207 |
Italy |
Ch. Tanker |
2-nd Off |
12.11.2009 |
23.03.2010 |
| Experience at sea: Since 2000 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 18.05.2009 | |||