APPLICATION FORM
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APPLICATION FORM |
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| Name: Oleksandr | Surname: Shcherbyna | ||||||
| Date of birth: 22.12.1985 | Place of birth: Ukraine | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): AX 430715 | Place of issue: Kherson | Date of issue: 12.05.2003 | Valid until: 12.05.2013 | ||||
| Seaman’s book: AB 181172 | Place of issue: Izmail | Date of issue: 28.11.2007 | Valid until: 28.11.2012 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | mother - Shcherbyna Svetlana | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Kherson maritime college | Navigator | . | 2005 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00190/2005/11 | Kherson |
28.07.2005 |
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| Endorsement STCW | 00190/2005/11 | Kherson |
28.07.2005 |
24.01.2010 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 7019/05 KH | Kherson |
19.05.2005 |
19.05.2010 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00128/2005/11 | Kherson |
28.07.2005 |
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| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00128/2005/11 | Kherson |
28.07.2005 |
24.01.2010 |
| Radar Observation and Plotting (A-II/1,2) | 0320/05 KH | Kherson |
19.05.2005 |
19.05.2010 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 0320/05 KH | Kherson |
19.05.2005 |
19.05.2010 |
| Advanced Fire Fighting (A-VI/3) | 3008/05 KH | Kherson |
19.05.2005 |
19.05.2010 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 4227/05 KH | Kherson |
19.05.2005 |
19.05.2010 |
| Medical First Aid (A-VI/4-1) | 2304/05 KH | Kherson |
19.05.2005 |
19.05.2010 |
| Ship Safety Officer | 01406/05 KH | Kherson |
27.10.2005 |
27.10.2010 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 001395/2005/04 | Odessa |
16.09.2005 |
16.09.2010 |
| Computer operator | XE 27924454 | Kherson |
06.06.2005 |
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| Belize Endorsement | 0822-06 | Belize |
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Tanker Certificates: |
. |
. |
. |
. |
| Tanker Familiarization | 0107/03 KH | Kherson |
12.12.2003 |
12.12.2008 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Gimalay | World line Ltd |
200 |
Ukraine |
Pass |
Deck cadet |
05.2003 |
09.2003 |
| Imandra | ASC Ukrrichflot |
35.5 |
Ukraine |
Tug |
AB |
02.2004 |
05.2004 |
| Volgo-Balt 28 | Maroon Shipping Co. Ltd |
2406 |
Belize |
Dry cargo |
AB |
06.2004 |
12.2004 |
| Volgo-Balt 26 | Maroon Shipping Co. Ltd |
2406 |
Belize |
Dry cargo |
Off in apprent |
12.2005 |
03.2006 |
| Volgo-Balt 26 | Maroon Shipping Co. Ltd |
2406 |
Belize |
Dry cargo |
2-nd Off |
03.2006 |
08.2006 |
| Ionian Assos | Sigma marine |
2408 |
St. Vincent |
Gen cargo |
2-nd Off |
12.2006 |
07.2007 |
| Experience at sea: Since 2002 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||