APPLICATION FORM
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APPLICATION FORM |
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| Name: Dmytro | Surname: Voloshyn | ||||||
| Date of birth: 27.03.1980 | Place of birth: Odessa | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AT 285762 | Place of issue: Odessa | Date of issue: 05.04.2002 | Valid until: 05.04.2012 | ||||
| Seaman’s book: AB 305519 | Place of issue: Illichivsk | Date of issue: 11.09.2007 | Valid until: 09.09.2012 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Voloshyna Aleksandra | ||||||
| Supported children under age of 18 |
Denis Voloshyn, 05.07.2005 | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Odessa National Maritime Academy | Deep Sea Navigator | 02.2003 | |||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00171/2009/03 | Illichivsk |
28.05.2009 |
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| Endorsement STCW | 00171/2009/03 | Illichivsk |
28.05.2009 |
31.07.2012 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | LZ 08782B | Odessa |
31.07.2007 |
29.07.2012 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00485/2003/08 | Odessa |
24.03.2003 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00485/2003/08 | Illichivsk |
29.08.2007 |
09.08.2012 |
| Radar Observation and Plotting (A-II/1,2) | 10974-2009 MT | Odessa |
20.03.2009 |
20.03.2014 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 10974-2009 MT | Odessa |
20.03.2009 |
20.03.2014 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 382/06 | Odessa |
31.07.2007 |
29.07.2012 |
| Advanced Fire Fighting (A-VI/3) | LZ 03740B | Odessa |
31.07.2007 |
29.07.2012 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | LZ05647B | Odessa |
31.07.2007 |
29.07.2012 |
| Ship's Medical Care (A-VI/4-2) | 10632 MT | Odessa |
20.03.2009 |
20.03.2014 |
| Refresher and updating courses (II/1) | ÑÏÊ 621272 | Odessa |
23.03.2009 |
02.04.2009 |
| Malta Endorsement | 01124/2007/03 | Malta |
03.12.2007 |
22.09.2011 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Team Effort | Teamfuel |
38000 |
Malta |
Bulker |
2-nd Off |
16.10.2005 |
25.08.2006 |
| Team Spirit | Teamfuel |
38000 |
Malta |
Bulker |
2-nd Off |
19.12.2006 |
06.07.2007 |
| Team Spirit | Teamfuel |
38000 |
Malta |
Bulker |
2-nd Off |
18.09.2007 |
22.06.2008 |
| Conqueror | Leros Shipmanagement |
40000 |
Malta |
Bulker |
2-nd Off |
10.10.2008 |
18.02.2009 |
| Eighth Ocean | V.Ships |
19000 |
Malta |
Container |
2-nd Off |
08.08.2009 |
31.08.2009 |
| Maersk Vigo | V.Ships |
23000 |
Gibraltar |
Container |
2-nd Off |
18.09.2009 |
22.01.2010 |
| Experience at sea: Since 1998 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 03.2012 | |||