APPLICATION FORM
|
APPLICATION FORM |
|
| Name: Sergiy | Surname: Solovyov | ||||||
| Date of birth: 18.08.1963 | Place of birth: Poltava reg., Ukraine | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): EE 184946 | Place of issue: Kherson | Date of issue: 20.06.2008 | Valid until: 20.06.2018 | ||||
| Seaman’s book: AB 351740 | Place of issue: Kherson | Date of issue: 17.03.2006 | Valid until: 17.03.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Swetlana Solovyova | ||||||
| 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 | Technician-Navigator | . | 05.12.1999 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 02193/2003/01 | Izmail |
30.07.2003 |
--- |
| Endorsement STCW | 02193/2003/01 | Nikolaev |
06.08.2008 |
23.07.2013 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 06908/2008/42/01 | Nikolaev |
23.07.2008 |
23.07.2013 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00502/2003/01 | Izmail |
21.07.2003 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00502/2003/01 | Nikolaev |
06.08.2008 |
05.08.2013 |
| Radar Observation and Plotting (A-II/1,2) | 00848/2008/42/31 | Nikolaev |
23.07.2008 |
23.07.2013 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 00848/2008/42/31 | Nikolaev |
23.07.2008 |
23.07.2013 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 03762/2008/42/20 | Nikolaev |
23.07.2008 |
23.07.2013 |
| Advanced Fire Fighting (A-VI/3) | 03195/2008/42/04 | Nikolaev |
23.07.2008 |
23.07.2013 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 05583/2008/42/02 | Nikolaev |
23.07.2008 |
23.07.2013 |
|
Ship'sMedical Care (A-VI/4-2) |
00869/2008/42/06 | Nikolaev |
23.07.2008 |
23.07.2013 |
| Refresher and updating courses (II/1) | 814/08 | Nikolaev |
06.08.2008 |
06.08.2013 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 00441/2008/42/40 | Nikolaev |
23.07.2008 |
23.07.2013 |
| Ship Safety Officer | 00363/2008/42/44 | Nikolaev |
23.07.2008 |
23.07.2013 |
| Ship Handling Arrangements | 00922/2008/42/60 | Nikolaev |
23.07.2008 |
23.07.2013 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Captain George II | Efnav |
53000 |
Cyprus |
Bulk carrier |
2-nd Off |
09.07.2002 |
07.04.2003 |
| Midway II | Creacian |
43479 |
Cyprus |
Bulk carrier |
2-nd Off |
25.01.2004 |
05.06.2004 |
| Flipper | Danlave |
75000 |
Cyprus |
Bulk carrier |
2-nd Off |
18.10.2004 |
29.12.2005 |
| Spirit | Petrofin |
45526 |
Bahamas |
Bulk carrier |
2-nd Off |
27.04.2006 |
28.02.2007 |
| Enterprise | Petrofin |
45526 |
Bahamas |
Bulk carrier |
2-nd Off |
09.04.2007 |
28.04.2008 |
| Experience at sea: Since 1984 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 000779 | Issued: 08.07.2008 | Place: Kherson | Exp. date: 08.07.2009 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 02.04.2017 | |||