APPLICATION FORM
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APPLICATION FORM |
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| Name: Sergii | Surname: Sukhanov | ||||||
| Date of birth: 17.10.1958 | Place of birth: Nikolaev | ||||||
| Permanent address: Nikolaev, Ukraine | |||||||
| Passport (OVIR): EA 647569 | Place of issue: Nikolaev | Date of issue: 31.01.2008 | Valid until: 31.01.2018 | ||||
| Seaman’s book: AB 273870 | Place of issue: Nikolaev | Date of issue: 22.12.2003 | Valid until: 04.02.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Sukhanova Tatiyana | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Kaliningrad Higher Engineering Marine Academy | Engineer-Navigator | . | 1991 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 0613/2005/01 | Izmail |
13.09.2005 |
--- |
| Endorsement STCW | 0613/2005/01 | Nikolaev |
28.01.2009 |
11.10.2011 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 02273/2006/42/01 | Nikolaev |
11.10.2006 |
11.10.2011 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00446/2004/07 | Nikolaev |
24.06.2006 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00446/2004/07 | Nikolaev |
28.01.2009 |
27.01.2014 |
| Radar Observation and Plotting (A-II/1,2) | 02218/2006/42/03 | Nikolaev |
11.10.2006 |
11.10.2011 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 02218/2006/42/03 | Nikolaev |
11.10.2006 |
11.10.2011 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 00921/2006/42/20 | Nikolaev |
11.10.2006 |
11.10.2011 |
| Advanced Fire Fighting (A-VI/3) | 00746/2006/42/04 | Nikolaev |
11.10.2006 |
11.10.2011 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats | 01426/2006/42/02 | Nikolaev |
11.10.2006 |
11.10.2011 |
| Ship's Medical Care (A-VI/4-2) | 00215/2006/42/06 | Nikolaev |
11.10.2006 |
11.10.2011 |
| Panama Seaman's book | 12G0405489 | Panama |
07.07.2007 |
24.06.2009 |
| Panama Endorsement | 12G0405489 | Panama |
07.07.2007 |
24.06.2009 |
| Belgium Seaman's book | 08548 | Belgium |
26.03.2008 |
--- |
| Belgium Endorsement | 58086/REC-D/016615/95 | Belgium |
18.03.2008 |
24.06.2009 |
| Ship Handling Arrangements | 00921/2006/42/20 | Nikolaev |
11.10.2006 |
11.10.2011 |
| Ship Security Officer | 000344/2008/08 | Nikolaev |
29.12.2008 |
29.12.2013 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Aigiorgis | Mariteam Service Inc |
17876 |
Malta |
Bulk carrier |
2-nd Off |
09.2004 |
04.2005 |
| Mariner | Rapid Ocean Co Ltd |
26605 |
Malta |
Bulk carrier |
2-nd Off |
11.2005 |
06.2006 |
| Medspiliani | Medlink Management S.A. |
26700 |
Panama |
Bulk carrier |
2-nd Off |
04.2007 |
12.2007 |
| CMB Yangtze | Bosimar International N.V. |
55085 |
Belgium |
Bulk carrier |
2-nd Off |
03.2008 |
07.2008 |
| Experience at sea: Since 1985 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ 005897 | Issued: 21.10.2008 | Place: Nikolaev | Exp. date: 21.10.2009 |
| Vaccination for cholera valid until: 12.08.2010 | Vaccination for yellow fever valid until: 13.12.2009 | |||