APPLICATION FORM
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APPLICATION FORM |
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| Name: Sergiy | Surname: Shvatskyy | ||||||
| Date of birth: 01.01.1983 | Place of birth: Donetsk Deg. | ||||||
| Permanent address: Mariupol, Ukraine | |||||||
| Passport (OVIR): AT 160016 | Place of issue: Mariupol | Date of issue: 18.10.2001 | Valid until: 18.10.2011 | ||||
| Seaman’s book: AB 321472 | Place of issue: Mariupol | Date of issue: 07.04.2006 | Valid until: 07.04.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 13.04.2013 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Shvatskaya Natalya - pas. No AT 673854 | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Rostov Marine College | Navigator | ÑÁ 4326507 | 02.07.2003 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 01408/2003/07 | Nikolaev |
26.08.2003 |
-- |
| Endorsement STCW | 01408/2003/07 | Mariupol |
18.07.2008 |
14.10.2010 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 17057-AS | Mariupol |
28.11.2006 |
28.11.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00036/2006/06 | Mariupol |
28.03.2006 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00036/2006/06 | Mariupol |
28.03.2006 |
14.10.2010 |
| Radar Observation and Plotting (A-II/1,2) | 972 KC | Mariupol |
02.05.2008 |
02.05.2013 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 972 KC | Mariupol |
02.05.2008 |
02.05.2013 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 10697 KC | Mariupol |
05.05.2008 |
05.05.2013 |
| Advanced Fire Fighting (A-VI/3) | 11711-AS | Mariupol |
07.05.2008 |
07.05.2013 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 13026-AS | Mariupol |
08.05.2008 |
08.05.2013 |
| Ship's Medical Care (A-VI/4-2) | 1061 KC | Mariupol |
07.05.2008 |
07.05.2013 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Amalia | Marinio Shipping Co |
13226 mt |
Cyprus |
Cont |
AB |
08.01.2004 |
21.09.2004 |
| Tiger Power | Lomar Shipping Ltd |
13226 mt |
Cyprus |
Cont |
3-rd Off |
21.03.2005 |
25.10.2005 |
| Atlos | Golden Ship Maritime Co |
14038 mt |
Malta |
Gen cargo |
3-rd Off |
19.04.2006 |
29.09.2006 |
| Kota Pemimpin | Henseatic Shipping |
39276 mt |
Liberia |
Cont |
3-rd Off |
04.01.2007 |
26.06.2007 |
| Santa Felicita | Claus-Peter Offen |
32458 mt |
Liberia |
Cont |
3-rd Off |
17.10.2007 |
22.03.2008 |
| CMA CGM Niger | Claus-Peter Offen |
32458 mt |
Liberia |
Cont |
2-nd Off |
19.08.2008 |
20.12.2008 |
| Experience at sea: Since 2003 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 2378 | Issued: 11.08.2008 | Place: Mariupol | Exp. date: 11.08.2009 |
| Vaccination for cholera valid until: 23.10.2011 | Vaccination for yellow fever valid until: 24.04.2012 | |||