Father's name: Vitaliyovych

OS APPLICATION FORM

POSITION APPLIED FOR: __OS____________

Personal data 01.09.2015

Family Name: Konuh	Name: Sergey	Father's name: Vitaliyovych
Date of birth: 01/04/1997	Place of birth: Ukraine,Kherson	Nationality: ukrainian
Marital status: Single	Children (name & DOB): No
Address : 57 Schmidt str., Nyzhni Sirohozy vill.,Kherson,Ukraine	Tel (including city code):	Mobile; [phone]
Next of kin and relationship: Mother Konuh Maryna Yuriivna
Next of kin’s address : 57 Schmidt str., Nyzhni Sirohozy vill.,Kherson,Ukraine	Tel: + 380500115728
Inter. P’port No: FB 456070	Issued: 08/05/2015	Valid: 08/05/2025	Place of issue: Kherson
Seaman's book No: AB515786	Issued: 09/01/2014	Valid: 20/12/2018	Place of issue: Kherson
Civil P’port No: MP400048	Place of issue: Nyzhni Sirohozy vill.,Kherson,Ukraine	Date of issue: 30/04/2013
USA Visa No:	Issued:	Valid:	Place of issue:

Medical information

Medical examination	Issued:21/01/2015	Valid:21/01/2016	Weight, kg: 60	Height, cm: 169
Drug & alcohol test	Issued:	Valid:	Eyes: Blue	Hair: Black
Yellow fever	Issued:	Valid:	Overall size: 60	Safety shoes: 40

Name of marine school attended	Address of school	From	To	Degree of diploma
Sea college of the Kherson state sea academy	Kherson, Ushakov Avenue, 14/1	01/09/2012		Navigator

National License

Certificate of competency hold	Number	Issued	Valid	Place of issue
Диплом			unlimited
Endorsement

IMO	STCW Certificates	Number	Issued	Valid	Place of issue
	OS Endorsement	№ 004421	12.03.2015	12.03.2019	Nikolaev
	Carriage of dangerous and hazardous substances
1.08	ARPA (A-I/12, A-II/1, A-II/2, B-I/12)
	Personal safety (A-VI/1) (IMO 1.13, 1.19, 1.20, 1.21)
2.03	Advanced fire fighting (A-VI/3)
1.23	Prof. in survival craft (A-VI/2 p.1-4)	№ 00966	10.04.2014	10.04.2019	Nikolaev
	Designated security duties of shipboard personnel
	Basic training and instruction for all seafarers	№ 14365	21.02.2014	21.02.2019	Nikolaev
	Crane Handling Simulator
1.14	Medical first aid (A-VI/4-1)
1.15	Medical care (A-VI/4-2)
	Hazardous cargoes (B-V/4, B-V/5)
	Safety officer (ISM code)
	Crowd management (A-V/3)
	Bridge Team Management
	Training for person. serving onpassenger ships other than RO-RO pas.ships
	RoRo passenger (A-V/2-1,-2,-3,-4,-5)
	Ship security officer
	Ship handling arrangements
	Свид-ство о повышении квалификации

Dangerous cargoes certificates

1.01	Oil tank. familiarization (A-V/1)
1.02	Oil tank.Specialized training (A-V/1,p.9-14)
1.03	Chem. tank. familiarization (V/1)				.
1.04	Chem. tank. advanced (A-V/1,p.16-21)
1.05	LPG familiarization (V/1)
1.06	LPG advanced (A-V/1,p.23-34)

Дата добавления: 2015-11-04