Application Form (Deck Officer)

Application Form (Deck Officer)

Name: Dmytro	Surname: Chynyakov
Date of birth:08.02.1982	Place of birth:Mariupol
Permanent address: 133, ave. Pobedy fl. 26
Phone: [phone]; mob. [phone]
Passport (OVIR) №: EA254515	Place of issue: Mariupol	Date of issue: 20.09.2007	Valid until: 20.09.2017
Seaman’s book №: AB323236	Place of issue: Mariupol	Date of issue: 28.11.2006	Valid until: 12.01.2016
Citizenship: Ukraine	Expiry date of U.S. visa: 16.11.2009
Marital Status: Single	Married Single Divorced Widower
Next of kin: (name, pas. No)	Wife - Antonyna, national passport BK 580212
Supported children under age of 18	1.NO
(name, surname, date of birth)	2.NO
Knowledge of English language:	Very good Good Satisfactory Fair Poor
Other language knowledge:

Education:	Qualification:	Date of Issue
College:: Mariupol Nautical Lyceum	sailor	07.06.2007
Academy: AMI ONMA	Navigator	25.01.2011

Certificates of STCW 78/95	No.	Place	Date of issue	Expiry date
Certificate of competency	00548/2011/06	Mariupol	07.12.2011
Endorsement STCW	00548/2011/06	Mariupol	07.11.2011	04.11.2016
Personal Sea Survival (БЖС) (A-VI/1)	116811 MA	Mariupol	15.11.2011	15.11.2016
G.M.D.S.S. General Operator (A-IV/2) Certificate	00174/2011/06	Mariupol	18.11.2011
G.M.D.S.S. General Operator (A-IV/2) Endorsement	00174/2011/06	Mariupol	18.11.2011	11.11.2016
Radar Observation and Plotting (A-II/1,2)	11343 KC	Mariupol	04.11.2011	04.11.2016
Automatic Radar Plotting Aids (ARPA) (A-II/1,2)	11343 KC	Mariupol	04.11.2011	04.11.2016
Carrying dangerous & hazardous cargo (B-V/4, B-V/5)	2566 KC	Mariupol	08.11.2011	08.11.2016
Advanced Fire Fighting (A-VI/3)	03443 MA	Mariupol	22.11.2011	22.11.2016
Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2)	115557 MA	Mariupol	17.11.2011	17.11.2016
Ship’s Medical Care (A-VI/4-2)
Medical First Aid (A-VI/4-1)	4255 MA	Mariupol	25.11.2011	25.11.2016
Refresher and updating courses (II/1)
Passenger ships other than Ro-Ro (A-V/3)
Dutch Endorsement
Another country Seaman’s book	MH157734	Marshal Islands	17.02.2009	16.02.2014
SHIP SECURITY OFFICER	000200/2011/03	Mariupol	26.12.2011	26.12.2016

Tanker Certificates:	No.	Place	Date of issue	Expiry date
Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7)
LPG carrier (Advanced and Familiarization, A-V/1, p.2-7)
Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7)
Cargo equipment on Tankers (A-V/1, paragraph 1)
Crude oil washing
Inert gas system

Sea service (during five last years):

Name of vessel	Company	HP/DWT	Flag	Type	Position	Period of service
From	To
LYCAVITOS	Adriatico-Mariupol		BARBADOS	Bulk carrier	O.S.	01.12.2007	18.07.2008
DATCA	SHOK Marine		Marshal Islands	Ro-Ro	O.S.	10.12.2008	28.04.2009
METEORA	Adriatico-Mariupol		Cayman Islands	Bulk carrier	O.S	23.07.2010	25.10.2010
ATHOS	Adriatico-Mariupol		Cayman Islands	Bulk carrier	A.B	28.02.2011	17.10.2011
ALFA MARE	Bermudas-Mariupol		Panama	Bulk cerrier	3-rd OFF	19.03.2012	06.10.2012

Experience at sea since

Knowledge Personal Computer (Yes / No): YES

Medical Certificate	Issued:	Place: Mariupol	Exp.date:
Vaccination for cholera valid until:	Vaccination for yellow fever valid until: 26.11.2017

I hereby affirm the information provided by me in this application is true and correct to the best my knowledge and belief. Further, that no Certificate of Competency or License issued to me has ever been revoked or suspended that I agree to any previous employer being contacted for a reference and consent to a drugs and alcohol test if required. I agree that the information about me is opened to free access.

Ready to work from:______02.04.2013_________

Date: ___02.04.2013____ Signature Chynyakov D.A.

Дата добавления: 2015-11-04