APPLICATION FORM
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APPLICATION FORM |
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| Name: Yevgen | Surname: Marakhovsky | ||||||
| Date of birth: 05.12.1975 | Place of birth: Izmail | ||||||
| Permanent address: Izmail, Odessa reg., Ukraine | |||||||
| Passport (OVIR): AM 662245 | Place of issue: Izmail | Date of issue: 24.07.2000 | Valid until: 01.01.2012 | ||||
| Seaman’s book: AB 432020 | Place of issue: Izmail | Date of issue: 01.10.2009 | Valid until: 01.10.2014 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 29.05.2011 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Marakhovskay Nataliya | ||||||
| Supported children under age of 18 | 1. Marakhovskay Kateryna | ||||||
| (name, surname, date of birth) | 2. Marakhovskay Yelyzaveta | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kyiv State Maritime Academy | Navigator | 13.04.2006 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00090/2006/07 | Nikolaev |
19.04.2006 |
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| Endorsement STCW | 00090/2006/07 | Nikolaev |
09.03.2006 |
09.03.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 85879 KT | Kyiv |
24.03.2006 |
24.03.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00086/2006/07 | Nikolaev |
19.04.2006 |
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| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00086/2006/07 | Nikolaev |
19.04.2006 |
03.03.2011 |
| Radar Observation and Plotting (A-II/1,2) | 5965 KT | Kyiv |
17.03.2006 |
17.03.2011 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 5925 KS | Kyiv |
17.03.2006 |
17.03.2011 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 0668 KS | Kyiv |
08.03.2006 |
08.03.2011 |
| Advanced Fire Fighting (A-VI/3) | 34246 KT | Kyiv |
07.04.2006 |
07.04.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 01632 KT | Kyiv |
31.03.2006 |
31.03.2011 |
| Medical First Aid (A-VI/4-1) | 01333 KT | Kyiv |
03.03.2006 |
03.03.2011 |
| Ship's Medical Care (A-VI/4-2) | 01333 KT | Kyiv |
03.03.2006 |
03.03.2011 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Forest Venture | Lemissoler |
13900 |
Cyprus |
Gen cargo |
3-rd Off |
16.06.2006 |
30.10.2006 |
| Smitwijs Singapore | Smit Singapore |
2700 |
Dutch |
Sea tug |
2-nd Off |
18.12.2006 |
08.02.2007 |
| Pearl Ray | Stamco |
17980 |
Liberia |
Ro-Ro |
3-rd Off |
30.04.2007 |
12.09.2007 |
| Clonmore | North Atlantic Shipping |
7480(600TEU) |
Ireland |
Container |
2-nd Off |
12.01.2008 |
29.02.2008 |
| Texel | Wagenborg |
10000 |
Dutch |
Gen cargo |
2-nd Off |
05.05.2008 |
13.08.2008 |
| Clonmore | North Atlantic Shipping |
7480(600TEU) |
Ireland |
Container |
2-nd Off |
30.08.2008 |
17.12.2008 |
| Graceful Leader | Stamco |
20986 |
Bahamas |
Ro-Ro |
2-nd Off |
23.04.2009 |
27.08.2009 |
| Experience at sea: Since 2002 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccinationfor cholera valid until: | Vaccination for yellow fever valid until: 10.2010 | |||