APPLICATION FORM
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APPLICATION FORM |
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| Name: Sergiy | Surname: Mishchenko | ||||||
| Date of birth: 13.03.1985 | Place of birth: Russia | ||||||
| Permanent address: Donetsk, Ukraine | |||||||
| Passport (OVIR): EA 679464 | Place of issue: Donetsk | Date of issue: 08.02.2008 | Valid until: 08.02.2018 | ||||
| Seaman’s book: AB 323217 | Place of issue: Mariupol | Date of issue: 28.11.2006 | Valid until: 28.11.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Mishchenko Svetlana | ||||||
| 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 | Technical Navigator | 2006 | |||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 2020303932 | Taganrog |
26.12.2006 |
--- |
| Endorsement STCW | 2020303932 | Taganrog |
26.12.2006 |
02.11.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 114272 | Rostov |
29.11.2006 |
29.11.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 0079966 | Taganrog |
26.12.2006 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 0079966 | Taganrog |
26.12.2006 |
23.11.2011 |
| Radar Observation and Plotting (A-II/1,2) | 0083063 | Taganrog |
11.12.2006 |
10.12.2011 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0083063 | Taganrog |
22.12.2006 |
20.12.2011 |
| Advanced Fire Fighting (A-VI/3) | 052214 | Rostov |
09.11.2006 |
09.11.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 086293 | Rostov |
02.12.2006 |
02.12.2011 |
| Medical First Aid (A-VI/4-1) | 047707 | Rostov |
02.11.2006 |
02.11.2011 |
| Ship's Medical Care (A-VI/4-2) | 047707 | Rostov |
02.11.2006 |
02.11.2011 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 00068/2008/03 | Mariupol |
17.03.2008 |
14.03.2013 |
| Dominica Seaman's book | 031385040701 | Dominica |
29.05.2007 |
29.05.2012 |
| Dominica Endorsement | CD-14637702 | Dominica |
29.05.2007 |
29.05.2012 |
| Marshall islands Seaman's book | MH 133426 | Marshall |
24.03.2008 |
23.03.2013 |
| Marshall islands Endorsement | 129998 | Marshall |
04.04.2008 |
02.11.2011 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Kalitva | Donmaster Ltd |
3000 |
Russia |
Bulk carrier |
AB |
18.09.2005 |
20.12.2005 |
| Kalitva | Donmaster Ltd |
3000 |
Russia |
Bulk carrier |
AB |
30.03.2006 |
03.10.2006 |
| Kalitva | Donmaster Ltd |
3000 |
Russia |
Bulk carrier |
3-rd Off |
25.01.2007 |
15.03.2007 |
| Gronx | Gronx Ltd S.A. |
15000 |
Dominica |
Bulk carrier |
3-rd Off |
09.04.2007 |
07.08.2007 |
| Gronx |
Gronx Ltd S.A. |
15000 |
Dominica |
Bulk carrier |
2-nd Off |
07.08.2007 |
20.12.2007 |
| Lark | Lilium Marine Co |
53550 |
Marshall isl |
Bulk carrier |
2-nd Off |
18.03.2008 |
17.10.2008 |
| Navios Star | Star Maritime Enterp. Co |
76662 |
Panama |
Bulk carrier |
2-nd Off |
03.05.2009 |
30.10.2009 |
| Experience at sea: Since 2004 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: 13.04.2009 | Place: Odessa | Exp. date: 13.04.2011 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 14.06.2013 | |||