APPLICATION FORM
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APPLICATION FORM |
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| Name: Oleksandr | Surname: Trybenko | ||||||
| Date of birth: 16.12.1982 | Place of birth: Kherson reg. | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): AH 826824 | Place of issue: Kherson | Date of issue: 16.03.2001 | Valid until: 16.03.2011 | ||||
| Seaman’s book: AB 326789 | Place of issue: Kherson | Date of issue: 22.02.2005 | Valid until: 22.02.2010 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 27.01.2013 | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | brother - Andrey Trybenko, MP 028026 | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Kherson Maritime College | Navigator | . | 2002 | ||||
| Kherson Maritime High School | Navigator (Bachelor) | . | 2007 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00140/2002/07 | Nikolayev |
04.08.2002 |
--- |
| Endorsement STCW | 00140/2002/07 | Nikolayev |
21.11.2007 |
31.10.2012 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 04848/2007/42/01 | Nikolayev |
31.10.2007 |
31.10.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00390/2002/07 | Nikolayev |
25.08.2002 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00390/2002/07 | Nikoayev |
21.11.2007 |
20.11.2012 |
| Radar Observation and Plotting (A-II/1,2) | 00266/2007/42/30 | Nikolayev |
31.10.2007 |
31.10.2012 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 00266/2007/42/30 | Nikolayev |
31.10.2007 |
31.10.2012 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 02497/2007/42/20 | Nikolayev |
31.10.2007 |
31.10.2012 |
| Advanced Fire Fighting (A-VI/3) | 02051/2007/42/04 | Nikolayev |
31.10.2007 |
31.10.2012 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 03699/2007/42/02 | Nikolayev |
31.10.2007 |
31.10.2012 |
| Medical First Aid (A-VI/4-1) | 01369/2007/42/05 | Nikolayev |
31.10.2007 |
31.10.2012 |
| Dutch Seaman's book | 00520002 | Hague |
31.01.2008 |
29.01.2018 |
| Dutch Endorsement | 00140/2002/07 | Hague |
21.02.2008 |
31.10.2012 |
| Antilles Seaman's book | 33191 | N.Antilles |
24.06.2005 |
24.06.2010 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Heide J | Marlow Navigation Co Ltd |
2481 |
. |
Container |
Deck cadet |
25.04.2003 |
22.08.2003 |
| Memel | Marlow Navigation Co Ltd |
2997 |
. |
Dry cargo/Cont |
OS |
01.02.2004 |
05.06.2004 |
| Askania | Marlow Navigation Co Ltd |
4291 |
. |
Cont/Ro-Ro/Ro-Lo |
OS |
01.05.2005 |
24.10.2005 |
| Niledutch Nordica | Marlow Navigation Co Ltd |
4999 |
. |
Cont/Ro-Ro/Ro-Lo |
AB |
06.06.2006 |
14.12.2006 |
| Kent Explorer | Uniteam Marine Ltd |
7580 |
Netherlands |
Dry cargo/Cont |
Jun. Off |
29.01.2008 |
25.07.2008 |
| Beautriumph | Uniseashipping BV |
7000 |
Netherlands |
Gen cargo |
2-nd Off |
23.02.2009 |
04.09.2009 |
| Experience at sea: Since 2003 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: 16.01.2008 | Place: Odessa | Exp. date: 16.01.2010 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 29.01.2011 | |||