APPLICATION FORM
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APPLICATION FORM |
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| Name: Yevhenii | Surname: Skrypka | ||||||
| Date of birth:04.05.1983 | Place of birth: Izmail, Ukraine | ||||||
| Permanent address: Izmail, Ukraine | |||||||
| Passport (OVIR): AH 842000 | Place of issue: Kherson | Date of issue: 01.02.2002 | Valid until: 01.02.2012 | ||||
| Seaman’s book: AB 186030 | Place of issue: Kherson | Date of issue: 27.04.2001 | Valid until: 21.03.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: Nill | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Mother - Skrypka Raisa | ||||||
| Supported children under age of 18 | - | ||||||
| (name, surname, date of birth) | - | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Kherson Marine College | Navigator | XE 25331082 | 06.07.2004 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 01805/2004/07 | Nikolaev |
19.10.2004 |
-- |
| Endorsement STCW | 01805/2004/07 | Nikolaev |
19.10.2004 |
01.07.2009 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 61610/MPS | Kherson |
23.09.2005 |
23.09.2010 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 0135/2004/07 | Nikolaev |
22.04.2004 |
-- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 0135/2004/07 | Nikolaev |
22.04.2004 |
06.04.2009 |
| Radar Observation and Plotting (A-II/1,2) | 1659 M/T | Odessa |
09.04.2004 |
09.04.2009 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 1659 M/T | Odessa |
09.04.2004 |
09.04.2009 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 1026/04KH | Kherson |
11.06.2004 |
11.06.2009 |
| Advanced Fire Fighting (A-VI/3) | 31502/MPS | Kherson |
30.07.2004 |
30.07.2009 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 48907/MPS | Kherson |
30.07.2004 |
30.07.2009 |
| Medical First Aid (A-VI/4-1) | 27581/MPS | Kherson |
30.07.2004 |
30.07.2009 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 01183/05KH | Kherson |
17.03.2005 |
17.03.2010 |
| Cyprus Seaman's Book | CY 102664 | Limassol |
14.11.2006 |
13.11.2009 |
| UK Seaman's Book | CEC0021861 | UK |
08.10.2007 |
01.07.2009 |
| Antigua and Barbuda Seaman's Book | 62459 | Antigua |
22.11.2006 |
21.11.2011 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Dnepr-2 | Ukrrechflot |
3086 |
Ukraine |
Dry Cargo |
3-rd Off |
18.03.2005 |
31.08.2005 |
| Dnepr-2 | Ukrrechflot |
3086 |
Ukraine |
Dry Cargo |
3-rd Off |
17.10.2005 |
23.04.2006 |
| M.Eregli | Kava Marine |
2119 |
Malta |
Dry Cargo |
2-nd Off |
07.06.2006 |
15.10.2006 |
| Pionner | Marlow Navigation |
660TUE |
Cyprus |
Container |
3-rd Off |
21.10.2006 |
25.05.2007 |
| Varmland | Marlow Navigation |
700TUE |
UK |
Container |
2-nd Off |
31.09.2007 |
30.03.2008 |
| MSC Nederland | MSC |
3000TUE |
Panama |
Container |
2-nd Off |
04.07.2008 |
12.11.2008 |
| 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: 05.02.2012 | |||