APPLICATION FORM
|
|
APPLICATION FORM |
|
| Name: Oleg | Surname: Melnyk | ||||||
| Date of birth: 20.06.1975 | Place of birth: Reni | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AC 713319 | Place of issue: Reni | Date of issue: 21.12.1998 | Valid until: 21.12.2008 | ||||
| Seaman’s book: AB 259913 | Place of issue: Odessa | Date of issue: 20.12.2002 | Valid until: 07.11.2007 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Juliya Menyk KK 517277 | ||||||
| Supported children under age of 18 | 1. Dariya Melnyk - 30.06.2000 | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Kyiv State Academy of WT | Navigator | KB 14270017 | 22.12.2000 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 02028/2005/01 | Izmail |
17.11.2005 |
--- |
| Endorsement STCW | 02028/2005/01 | Izmail |
17.11.2005 |
20.11.2007 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 86133 U | Izmail |
08.11.2005 |
08.11.2010 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 01858/2002/01 | Izmail |
11.12.2002 |
06.12.2007 |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 01858/2002/01 | Izmail |
11.12.2002 |
06.12.2007 |
| Radar Observation and Plotting (A-II/1,2) | 2927 U | Izmail |
09.11.2005 |
09.11.2010 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 2927 U | Izmail |
09.11.2005 |
09.11.2010 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 6473 KS | Kyiv |
20.11.2002 |
20.11.2007 |
| Advanced Fire Fighting (A-VI/3) | 37977 U | Izmail |
11.11.2005 |
11.11.2010 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 61869 U | Izmail |
10.11.2005 |
10.11.2010 |
| Medical First Aid (A-VI/4-1) | 33426 U | Izmail |
07.11.2005 |
07.11.2010 |
| Passenger ships other than Ro-Ro (A-V/3) | LZ 04984B | Odessa |
09.02.2004 |
09.02.2009 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Quinta | Lucca Ship. |
13900 |
Malta |
Bulker |
AB |
01.2002 |
10.2002 |
| Falcon | Tuan Ship. |
7300 |
Cambodia |
Bulker |
2-nd off. |
12.2002 |
07.2003 |
| Levante | Candid nav. |
19800 |
Panama |
Bulker |
2-nd off. |
03.2004 |
11.2004 |
| African cobra | EST |
26500 |
Bahamas |
Bulker |
2-nd off. |
02.2005 |
10.2005 |
| Ferosa | EST |
172000 |
St. Vinsent |
Bulker |
2-nd off. |
03.2006 |
10.2006 |
| Experience at sea: Since 1999 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 22.12.2016 | |||