матрос АВ

[Александр @]

PERSONAL DATA / APPLICATION FORM

Position applied for __________________ License hold ___________________ Date Available __________
Family Name: Kovalchuk Name: Oleksandr



Father's name: Leonid
Date of birth: 29 06 1986 Place of birth: Odessa



Nationality: Ukraine Marital status: single
Address: ,Odessa,Ukraine





Nearest Airport: ……………………………………………………………





Home phone:
E-mail: akaunt.11@mail.ru Mobile phone: 0930445599


Next of kin and relationship: Children (name & DOB):
Next of kin’s address: Next of kin tel:
Inter. P’port No: FH 483038 Issued: 15 07 17 Valid: 15 07 27 Place of issue: Odessa
Seaman's book No: AB 530404 Issued: 24 04 14 Valid: 24 04 19 Place of issue:Illichivsk
Civil P’port No:KK 960539



Place of issue: 05 07 2002
Date of issue: Odessa

USA visa No: Issued: Valid: Place of issue:
TOSE: MARLINS:
SEA GOING EXPERIENCE FOR THE LAST 7 YEARS
(MOST RECENT VESSEL LAST)
Name of vessel Year of built Company Owner /
Ship Manager Flag Type of vessel DWT /
TEU ME type /
Model BHP Rank From
DD/MM/YYYY To
DD/MM/YYYY

Leo Star 1 1995 Asterismos Navigation Corp Liberia Bulk Carrier 22763 AB 07 07 2018 09 12 2017
Nikiforos 1995 Poseidon Navigation Corp Liberia Bulk Carrier 45693 AB 24 04 2016 27 03 2017
Go Pub 1990 Go Pub Shipping S A Liberia Bulk Carrier 71761 oiler 25 09 2015 28 11 2015
Go Pub 1990 Go Pub Shipping S A Liberia Bulk Carrier 71761 AB 18 04 2015 25 09 2015
Severodvinsk
1965 Georgia 1944 AB 15 10 2013 15 05 2014
Kuber Tech Prjgect Bahamas Bulk Carrier 18507 OS 28 06 2011 06 02 2012


Name of Maritime Institution attended Address of institution From To Degree of Diploma
Maritime College Of Technical Fleet 2003 2008 Engineer
Maritime College Of Technical Fleet 2008 2010 Navigator

STCW Certificates Number Issued Valid Place of issue STCW Certificates Number Issued Valid Place of issue
Certificate of competency
Navigator
00898\2017\03

16.05.17


Illichivsk
GMDSS Endorsement 00897\2017\03 16 05 17 12 05 22 Illichivsk

Endorsement 00898\2017\03 16.05.17 12 05 22 Illichivsk Radar observer 2164 13 04 17 13 04 22 Chornomorsk
Personal safety 11989 10 04 17 10 04 22 Chornomorsk ARPA
Advanced fire fighting 02436 04 03 15 04 03 20 Odessa AIS course
Prof. in survival craft 00748 27 02 15 27 02 20 Odessa BTM course
Medical first aid 9846 13 04 17 13 04 22 Chornomorsk ECDIS course
Medical care Security officer (ISPS) 32424 27 02 15 27 02 20 Odessa
Hazardous cargoes 6359 13 04 17 13 04 22 Chornomorsk Safety officer (ISM)
Basic safety traning 00961 27 02 15 27 02 20 Odessa


Medical examination Issued: Valid: Weight, kg:88 Height, cm: 176
Drug & alcohol test Issued: Valid: Eyes: Hair:
Yellow fever Issued:23 05 2017 Valid:23 05 2027 Overall size: 44 Safety shoes: 42

Another States Seamen’s Books Rank Document No Issued Valid Another States Certificates of competency Rank Document No Issued Valid
Liberia Liberia
Panama Panama