APPLICATION FORM
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APPLICATION FORM |
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| Name: Volodymyr | Surname: Mykhaylov | Father’s name: Vadym | |||||||
| Date of birth: 15.03.1969 | Place of birth: Odessa | Personal Code: 2527601276 | |||||||
| Permanent address: Odessa, Ukraine | |||||||||
| Passport (OVIR): AH 594734 | Place of issue: Odessa | Date of issue: 17.08.1998 | Valid until: 17.08.2008 | ||||||
| Seaman’s book: AB 335735 | Place of issue: Odessa | Date of issue: 19.10.2005 | Valid until: 19.10.2010 | ||||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||||
| Marital Status | Married | ||||||||
| Next of kin: (name, pas. No) | wife - Tkachenko Viktoriya | ||||||||
| Supported children under age of 18 | Ann Tkachenko - 20.08.1987 | ||||||||
| (name, surname, date of birth) | -- | ||||||||
| Knowledge of English language | Good | ||||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||||
| Odessa State Marine Academy | Navigator | CK 25283274 | 01.06.2004 | ||||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00048/2007/01 |
Izmail |
18.07.2007 |
--- |
| Endorsement STCW | 00048/2007/01 |
Izmail |
18.07.2007 |
16.05.2012 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 91710/2007 |
Odessa |
17.05.2007 |
17.05.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00231/2004/03 |
Izmail |
18.07.2007 |
23.05.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00231/2004/03 |
Izmail |
18.07.2007 |
23.05.2012 |
| Radar Observation and Plotting (A-II/1,2) | 0523 MT |
Odessa |
18.05.2007 |
18.05.2012 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0523 MT |
Odessa |
18.05.2007 |
18.05.2012 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 0895/2007 |
Odessa |
16.05.2007 |
16.05.2012 |
| Advanced Fire Fighting (A-VI/3) | 46512/2007 |
Odessa |
17.05.2007 |
17.05.2012 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 52024/2007 |
Odessa |
16.05.2007 |
16.05.2012 |
| Ship's Medical Care (A-VI/4-2) | 2162 MT |
Odessa |
18.05.2007 |
18.05.2012 |
| Ro-Ro passenger ships (A-V/2) | 0022/2004 |
Odessa |
02.02.2004 |
02.02.2009 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 |
2479/2004 |
Odessa |
09.07.2004 |
09.07.2009 |
| Seafarer's identitydocument & record book | 725075 | Liberia |
15.11.2005 |
15.11.2010 |
| Licence of competence to merchant marine officer | 769646 | Liberia |
15.11.2005 |
01.06.2009 |
| Endorsement certificat of competence | 36852 | Malta |
05.10.2004 |
01.06.2009 |
| Certificate of maritime competence | Cy 014665 | Cyprus |
05.07.2002 |
05.07.2012 |
| Automatic Identification system | 0072/2005 |
Odessa |
31.10.2005 |
31.10.2010 |
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Tanker Certificates: |
. |
. |
. |
. |
| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 0065/2004 |
Odessa |
20.02.2004 |
20.02.2009 |
| LPG caggier (Advanced and Familiarization, A-V/1, p.2-7) | 0065/2004 |
Odessa |
20.02.2004 |
20.02.2009 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 0065/2004 |
Odessa |
20.02.2004 |
20.02.2009 |
| Cargo equipment on Tankers (A-V/1, paragraph 1) | 0065/2004 |
Odessa |
20.02.2004 |
20.02.2009 |
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Despina | John Giavridis Inc. |
18233 |
Malta |
General Cargo Cont |
2-nd Off |
24.09.2004 |
04.06.2005 |
| Baltic Mariner | Aquaship LTD |
9852 |
Liberia |
Reefer cont |
2-nd Off |
03.11.2005 |
07.05.2006 |
| Baltic Mariner | Aquaship LTD |
9852 |
Liberia |
Reefer cont |
2-nd Off |
01.07.2006 |
10.12.2006 |
| Baltic Strait | Aquaship LTD |
. |
Panama |
Reefer cont |
Ch. Off |
20.08.2007 |
28.12.2007 |
| Johnny P | P&P Shipping Co |
27903 |
Malta |
Bulk |
Ch. Off |
26.01.2008 |
27.05.2008 |
| Altair | Scarllati Ventures Inc |
23284 |
Panama |
Gen cargo/Heeavy |
Ch. Off |
07.08.2008 |
26.12.2008 |
| Experience at sea: Since 1992 | Knowledge Personal Computer: Yes |
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: January 2013 | |||