APPLICATION FORM
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APPLICATION FORM |
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| Name: Maksim | Surname: Yonyk | ||||||
| Date of birth: 10.12.1981 | Place of birth: Tadjikistan | ||||||
| Permanent address: Kerch, Ukraine | |||||||
| Passport (OVIR): AE 515908 | Place of issue: Kerch | Date of issue: 25.03.2002 | Valid until: 25.03.2012 | ||||
| Seaman’s book: AB 273701 | Place of issue: Kiev | Date of issue: 15.10.2003 | Valid until: 15.10.2008 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Yonyk Irina | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Kiev State Maritime Academy | Navigator | KB 25887114 | 23.12.2004 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00087/2005/01 | Izmail |
26.01.2005 |
13.09.2008 |
| Endorsement STCW | 00087/2005/01 | Izmail |
26.01.2005 |
13.09.2008 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 54171 KS | Kiev |
13.09.2003 |
13.09.2008 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00302/00302 | Kiev |
21.04.2004 |
21.04.2009 |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00302/00302 | Kiev |
21.04.2004 |
21.04.2009 |
| Radar Observation and Plotting (A-II/1,2) | 863 KS | Kiev |
05.03.2004 |
05.03.2009 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 863 KS | Kiev |
05.03.2004 |
05.03.2009 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 14772 KS | Kiev |
26.12.2004 |
26.12.2009 |
| Advanced Fire Fighting (A-VI/3) | 29435 KS | Kiev |
26.02.2004 |
26.02.2009 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 45633 KS | Kiev |
05.03.2004 |
05.03.2009 |
| Medical First Aid (A-VI/4-1) | 26070 KS | Kiev |
29.02.2004 |
09.02.2009 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Flora | KMFP |
2011 |
Ukraine |
SLV |
A/B |
15.08.2001 |
01.11.2001 |
| Cappadocia | Cappadocia ship Inc-Panama |
1900 |
Panama |
Cargo-Passenger |
Deck-Cadet |
18.10.2003 |
20.04.2004 |
| Minusinsk | KSC |
2360 |
Russia |
Dry Cargo |
A/B |
19.05.2004 |
19.06.2004 |
| Danapris 2 | VDSC |
2360 |
Russia |
Dry Cargo |
A/B |
19.06.2004 |
19.09.2004 |
| Leda | Target Marine |
75000 |
Marshall Island |
Bulk Carrier |
A/B |
12.05.2005 |
29.11.2005 |
| Gregorio | Trans Atlantic |
7000 |
Panama |
General cargo |
3-rd Off |
10.05.2006 |
05.12.2006 |
| Mostein | Nordic Maritime |
3000 |
Bahamas |
General cargo |
2-nd Off |
01.02.2007 |
18.07.2007 |
| Experience at sea: Since 2001 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 24.02.2012 | |||