APPLICATION FORM
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APPLICATION FORM |
|
| Name: Oleksiy | Surname: Plotnikov | ||||||
| Date of birth: 23.08.1979 | Place of birth: Ukraine | ||||||
| Permanent address: Kerch, Ukraine | |||||||
| Passport (OVIR): AK 595596 | Place of issue: Kerch | Date of issue: 28.03.2005 | Valid until: 28.03.2015 | ||||
| Seaman’s book: AB 256578 | Place of issue: Kerch | Date of issue: 30.03.2005 | Valid until: 30.03.2010 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 16.05.2011 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Plotnikova Marina, EC 360797 | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kherson Marine Academy | Navigator | 14.08.2007 | |||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 01324/2007/07 | Nikolaev |
14.08.2007 |
--- |
| Endorsement STCW | 01324/2007/07 | Nikolaev |
14.08.2007 |
14.08.2012 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 11059/07 KH | Kherson |
24.05.2007 |
24.05.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00268/2007/07 | Nikolaev |
18.06.2007 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00268/2007/07 | Nikolaev |
18.06.2007 |
18.06.2012 |
| Radar Observation and Plotting (A-II/1,2) | 1012/07 KH | Kherson |
25.05.2007 |
25.05.2012 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 1012/07 KH | Kherson |
25.05.2007 |
25.05.2012 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 2676/07 KH | Kherson |
18.05.2007 |
18.05.2012 |
| Advanced Fire Fighting (A-VI/3) | 5119/07 KH | Kherson |
24.05.2007 |
24.05.2012 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 7421/07 KH | Kherson |
24.05.2007 |
24.05.2012 |
| Medical First Aid (A-VI/4-1) | 4038/07 KH | Kherson |
24.05.2007 |
24.05.2012 |
| Ship's Medical Care (A-VI/4-2) | 4038/07 KH | Kherson |
24.05.2007 |
24.05.2012 |
| Antigua & Barbuda Seaman's book | 72976 | Ant&Barb |
15.10.2007 |
15.10.2012 |
| Antigua & Barbuda G.M.D.S.S. Endorsement | 18191R | Ant&Barb |
30.10.2007 |
30.10.2012 |
| Antigua & Barbuda Endorsement | 19399D | Ant&Barb |
30.10.2007 |
30.10.2012 |
| Marshall islands Seaman's book | M0120696 | Marshall |
21.05.2008 |
20.05.2013 |
| Marshall islands Endorsement | 01324/2007/07 | Marshall |
22.07.2009 |
21.05.2012 |
|
Tanker Certificates: |
. |
. |
. |
. |
| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 0593/07 KH | Kherson |
21.05.2007 |
21.05.2012 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) | 0596/07 KH | Kherson |
21.05.2007 |
21.05.2012 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 0596/07 KH | Kherson |
21.05.2007 |
21.05.2012 |
| Crude Oil Washing | 0202/2008 | Odessa |
16.05.2008 |
16.05.2013 |
| Inert gas system | 0183/2008 | Odessa |
16.05.2008 |
16.05.2013 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Hyunday Admiral | Zodiac |
51836 |
UK |
Cont |
OS |
20.06.2005 |
23.02.2006 |
| Bavaria Express | Zodiac |
39941 |
Malta |
Cont |
AB |
20.05.2006 |
17.12.2006 |
| Sky Vita | Alpha Shipping |
2497 |
Ant&Barb |
Dry cargo |
3-rd Off |
01.10.2007 |
27.02.2008 |
| Longfin | Prime Marine |
83962 |
MI |
Tanker |
3-rd Off |
20.05.2008 |
20.09.2008 |
| Skipjack | Prime Marine |
82560 |
MI |
Tanker |
3-rd Off |
26.05.2009 |
10.06.2009 |
| Skipjack | Prime Marine |
82560 |
MI |
Tanker |
2-nd Off |
10.06.2009 |
03.11.2009 |
| Experience at sea: Since 1997 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 05.06.2012 | |||