APPLICATION FORM
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APPLICATION FORM |
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| Name: Andriy | Surname: Reva | ||||||
| Date of birth: 22.03.1981 | Place of birth: Mariupol | ||||||
| Permanent address: Mariupol, Ukraine | |||||||
| Passport (OVIR): AT 334450 | Place of issue: Mariupol | Date of issue: 17.05.2001 | Valid until: 17.05.2011 | ||||
| Seaman’s book: AB 182349 | Place of issue: Mariupol | Date of issue: 24.05.2002 | Valid until: 17.09.2008 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 08.08.2010 | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | mother - Reva Lyubov, BA 725092 | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa State Maritime Academy | Bachelor of Navigation | CK 21187765 | 05.07.2002 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00196/2007/06 | Mariupol |
15.03.2007 |
--- |
| Endorsement STCW | 00196/2007/06 | Mariupol |
15.03.2007 |
17.01.2012 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 00625-AS | Mariupol |
23.01.2007 |
23.01.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00140/2002/06 | Mariupol |
30.07.2002 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00140/2002/06 | Mariupol |
26.02.2007 |
09.02.2012 |
| Radar Observation and Plotting (A-II/1,2) | 1334-AS | Mariupol |
02.02.2007 |
02.02.2012 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 1334-AS | Mariupol |
02.02.2007 |
02.02.2012 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 04428-AS | Mariupol |
19.01.2007 |
19.01.2012 |
| Advanced Fire Fighting (A-VI/3) | 07939-AS | Mariupol |
22.01.2007 |
22.01.2012 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 00374-AS | Mariupol |
17.01.2007 |
17.01.2012 |
| Ship's Medical Care (A-VI/4-2) | 02009-AS | Mariupol |
26.01.2007 |
26.01.2012 |
| Operational use of ECDIS (IMO 1.27) | 0274-AS | Mariupol |
16.02.2007 |
16.02.2012 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 000050/2005/03 | Mariupol |
24.01.2005 |
24.01.2010 |
|
Ship Handling Arrangement (A-II/2) (mangement level) |
0015-AS |
Mariupol |
14.02.2007 |
14.02.2012 |
|
Antigua & Barbuda Seamen's book |
53022 | Antigua |
24.10.2005 |
23.10.2010 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Makeevka | Cometas |
28136 |
Ukraine |
Bulk |
3-rd Off |
18.12.2002 |
19.08.2003 |
| Kiperousa | ATT Bermudas |
25370 |
Malta |
Bulk |
3-rd Off |
24.01.2004 |
26.03.2004 |
| Kiperousa | ATT Bermudas |
25370 |
Malta |
Bulk |
3-rd Off |
26.03.2004 |
17.12.2004 |
| Kiperousa | ATT Bermudas |
25370 |
Malta |
Bulk |
3-rd Off |
01.04.2005 |
16.06.2005 |
| ZIM Buenos Aires | Doehle Mariupol |
23320 |
Antigua |
Cont |
3-rd Off |
23.10.2005 |
09.04.2006 |
| Inga S | Doehle Mariupol |
14464 |
Antigua |
Cont |
3-rd Off |
16.07.2006 |
12.01.2007 |
| Inga S | Doehle Mariupol |
14464 |
antigua |
Cont |
2-nd Off |
05.04.2007 |
23.09.2007 |
| 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: 10.05.2011 | |||