| | | SEAFARER'S APPLICATION FORM | |
| Position: | 3 OFFICER/JDPO | Readiness: | 02.01.2017 | | Citizenship: | Ukraine | | Last name: | | Marital status | married | | First name | | Children: | Yes | | Middle name: | Grigorovich | Nationality: | Ukrainian | | Birth date: | 04.02.1983 | Birth place: | Ukraine | | Home address: | 203 Rabochaya Str., flt. 3,
Kherson, Ukraine | | | | | | | | English level: | Good | Schengen visa | 20.04.16 - 16.10.2016 |
| | |
Education |
| Educational institution | Speciality | Faculty | Place | Number | From | Till |
Kherson Maritime College
Nikolaev shipbuilding university | Navigator
Engineer | Navigation Bridge officer
Ref. Engineer | Kherson/UKR
Nikolaev/UKR | 00572/2011/11
MK 25957063 | 02.08.2010
01.09.1999
| 29.01.2014
28.06.2005 |
Passports, Licenses & Certificates | |
| Title | Class | Number | Place of issue | Issued | Valid | |
| Passports & Visas | |
| Seaman's book | AB 498637 | Kherson, UKR | 29.12.2011 | 11.06.2022 | |
| Travel passport | EP 054382 | , UKR | 12.06.2012 | 12.06.2022 | |
| Diplomas & Endorsements | |
| Diploma | II/1 | 10005/2014/11 | Kherson, UKR | 26.02.2014 | | |
| Diploma Endorsement | II/1 | 10005/2014/11 | Kherson, UKR | 26.02.2014 | 15.01.2019 | |
| Certificates & Licenses | |
| Advanced Fire Fighting (VI/3) | 7300 | Sevastopol, UKR | 13.01.2014 | 13.01.2019 | |
| Automatic Radar Plotting Aids (ARPA) | 927 | Sevastopol, UKR | 10.01.2014 | 10.01.2019 | |
| Basic Safety Training (VI/1.1-4) | 27 | Sevastopol, UKR | 14.01.2014 | 14.01.2019 | |
| Dangerous and Hazardous Substances (V4,V5) | 6 | Sevastopol, UKR | 10.01.2014 | 10.01.2019 | |
| GMDSS General Operator Certificate | 10004/2014/11 | Sevastopol, UKR | 26.02.2014 | 15.01.2019 | |
| Medical First Aid on board ship(VI/4.1) | 4 | Sevastopol, UKR | 15.01.2014 | 15.01.2019 | |
| Bridge team Management | 5 | Sevastopol, UKR | 31.01.2014 | 31.01.2019 | |
| Proficiency in Survival Craft and Rescue Boats (VI/2) | 10419 | Sevastopol, UKR | 15.01.2014 | 15.01.2019 | |
| Ship Security Officer (VI/2) | 232 | Sevastopol, UKR | 29.01.2014 | 29.01.2019 | |
| LGtank Tank Specialized Training | 478/MPS | Kherson, UKR | 13.06.2014 | 13.06.2019 | |
| ECDIS | 4558 | Sevastopol, UKR | 28.11.2014 | 28.11.2019 | |
| Medical Certificates | |
| Drug and Alcohol Test | 00883 | Kherson, UKR | 02.09.2015 | 02.09.2016 | |
| Medical Fitness Certificate | 00883/KN | Kherson, UKR | 02.09.2015 | 02.09.2016 | |
| Yellow Fever Vaccination | 00883 | Kherson, UKR | 02.09.2015 | 02.09.2025 | |
Sea-going experience | |
| | Vessel’s
name | Flag | Type | Engine | Rank | From | Shipowner | |
| Year | DWT | HP | Till | | |
| 1 | m/v «Ensco/Lads-1» | SKN | Deep Water Drilling Vessel | 3-rd Off | 01.06.2016 | Lyra Trading Limited | |
| 1999 | 29847 | 29160 kW | 20.09.2016 | Pasific Naval | |
| 2 | m/v “Pavel Postyshev” | UKR | General Cargo | 2-nd Off | 26.06.2015 | Kherson port | |
| 1974 | 3125 | | 15.02.2016 | PE “VIK” | |
| 3 | m/v “Pavel Postyshev” | UKR | General Cargo | 2-nd Off | 23.04.2014 | Kherson port | |
| 1974 | 3125 | | 19.01.2015 | PE “VIK” | |
| 4 | “SB 401” | UKR | Tanker Bunkering | Trainee Office | 30.08.2012 | Kherson port | |
| 1987 | 1100 | 540 | 04.03.2013 | PE “VIK” | |
| 5 | “SB 401” | UKR | Tanker Bunkering | Ordinary Seaman | 16.01.2012 | Kherson port | |
| 1987 | 1100 | 540 | 20.06.2012 | PE “VIK” | |
General Physical State | |
| Height (cm) | Weight (kg) | Shoes | Clothes | Hair color | Eye color | |
| 176 | 76 | 43 | M | grey | blue | |
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