APPLICATION FORM
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APPLICATION FORM |
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| Name: Sergiy | Surname: Strokin | ||||||
| Date of birth: 06.05.1957 | Place of birth: Turkmenistan | ||||||
| Permanent address: Kerch, Ukraine | |||||||
| Passport (OVIR): EA 163430 | Place of issue: Kerch | Date of issue: 23.08.2007 | Valid until: 23.08.2017 | ||||
| Seaman’s book: AB 015115 | Place of issue: Sevastopol | Date of issue: 24.05.2002 | Valid until: 24.05.2012 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 29.05.2008 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Strokina Valentina, EC 090789 | ||||||
| Supported children under age of 18 | 1. Yuriy Strokin - 30.07.1993 | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Very good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Rostov Marine College | Navigator | 990128 | 03.07.1976 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00148/2004/10 | Sevastopol |
26.03.2004 |
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| Endorsement STCW | 00148/2004/10 | Kerch |
31.07.2007 |
17.05.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | LZ 08272B | Odessa |
17.05.2006 |
17.05.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00096/2004/10 | Sevastopol |
26.03.2004 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00096/2004/10 | Kerch |
31.07.2007 |
13.06.2012 |
| Radar Observation and Plotting (A-II/1,2) | LZ 03249B | Odessa |
17.05.2006 |
17.05.2011 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | LZ 03249B | Odessa |
17.05.2006 |
17.05.2011 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | LZ 21043B | Odessa |
17.05.2006 |
17.05.2011 |
| Advanced Fire Fighting (A-VI/3) | LZ 02472B | Odessa |
17.05.2006 |
17.05.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | LZ 63091B | Odessa |
17.05.2006 |
17.05.2011 |
| Ship's Medical Care (A-VI/4-2) | LZ 08192B | Odessa |
17.05.2006 |
17.05.2011 |
| ECDIS | 0038 SV | Sevastopol |
05.07.2007 |
05.07.2012 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 0823/2004 | Odessa |
17.03.2004 |
17.03.2009 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Glorious Harvest | Wallem |
13794 |
Panama |
reefer |
Ch. Off |
02.07.2002 |
06.02.2003 |
| Cygnus Reefer | Wallem |
14544 |
Liberia |
reefer |
Ch. Off |
27.06.2003 |
22.01.2004 |
| Orion Reefer | Wallem |
14544 |
Panama |
reefer |
Ch. Off |
30.06.2004 |
26.01.2005 |
| Cygnus Reefer | Wallem |
14544 |
Liberia |
reefer |
Ch. Off |
04.05.2005 |
19.09.2005 |
| Cygnus Reefer | Wallem |
14544 |
Liberia |
reefer |
Master |
20.09.2005 |
11.01.2006 |
| Cygnus Reefer | Wallem |
14544 |
Liberia |
reefer |
Master |
05.08.2006 |
25.04.2007 |
| Experience at sea: Since 1976 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: 31.08.2007 | Place: Kerch | Exp. date: 31.08.2008 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 11.03.2015 | |||