Sea Way Maritime Agency

3 Pionerskaya Str, Sevastopol, 99008, Ukraine

Tel : (0692 )54 40 70, 54 38 78 / Fax : 55 03 26 E-mail:

APPLICATION FORM

POSITION APPLIED FOR / O/S / Cadet / Date: 14.08.2017
TO BE FILLED IN AS PER SEAMAN’S PASSPORT
Surname / Gurkovskiy / Name / Volodymyr
Father’s name / Vyacheslav / Mother’s name / Inna
Date of Birth / 23.02.1995 / Place of Birth / Genychesk, Ukraine / Nationality / ukrainian
Address / city Genychesk, Ukraine, Krasnoarmeyskaja street, 14 / Height/Weight / 180/80
Private Phone / Contact Phone / +380990256855 / Eyes color / brown
Next of Kin name/Relationship/Address / Gurkovskiy Vyacheslav/father/Kherson, Ukraine, Komkova street, 83
Gurkovska Inna/mother/Genychesk, Ukraine, Krasnoarmeyskaja street, 14
Nos. Of children under 18
Education / Name of Maritime College or Academy / From / Till
Kherson maritime college / 2010 / 2014
DOCUMENTS / NUMBER / ISSUED: Date / Place / Valid Till
Seaman’s passport / AB514533 / 04.06.2013/Kherson / 28.05.2018
Tourists Passport / EX249706 / 15.07.2013 Kherson / 15.07.2023
National (Citizen) Passport / MP361631 / 03.11.2011 Kherson / permanent
Visa USA
CERTIFICATES / GRADE / CLASS / NUMBER / ISSUED: Date / Place / Valid Till
Certificate of Competency / 12991/2014/07 / 26.09.2014, Kherson / Permanent
Endorsement / 12991/2014/07 / 28.03.2017, Kherson / 23.02.2022
Radar Observing Certificate
ARPA Certificate / 441 / 11.04.2014, Odessa / 11.04.2019
GMDSS Certificate / 12990/2014/07 / 26.09.2014, Nikolaev / Permanent
GMDSS Endorsement / 12990/2014/07 / 26.09.2014, Nikolaev / 06.06.2019
Bridge Team Management / 01458 / 07.04.2014, Odessa / 07.04.2019
Engine Team Management
Ship Safety Officer / 78/2014 / 10.04.2014, Odessa / 10.04.2019
Ship Security Officer / 2511 / 10.04.2014, Odessa / 10.04.2019
Foreign Licenses
STCW-CODE’95 CERTIFICATES
CERTIFICATES / NUMBER / ISSUED: Date / Place / Valid Till
1. Basic Safety Training / 03940 / 07.04.2014, Odessa / 07.04.2019
2. Proficiency in Survival Craft / 03426 / 07.04.2014, Odessa / 07.04.2019
3. Advanced FFT / 05451 / 07.04.2014, Odessa / 07.04.2019
4. Hazardous Cargoes / 1851 / 11.04.2014, Odessa / 11.04.2019
5. Medical First Aid / 4044 / 11.04.2014, Odessa / 11.04.2019
6. Medical Care on Board / 017408 / 30.01.2017, Kherson / 30.01.2018
7. Oil Tanker Familiarization
8. Crude Oil Washing Technology
9. Inert Gas System
10. Advanced Training on Oil Tankers
11. Chemical Tankers
12. Liquefied Gas Tankers
13. Ro-Ro Passenger Ships

SEA SERVICE (Last 5 Years)

Rank / Vessel’s Name / Type / dwt / M. E.
Type / Mark / BHP / Flag / From / To / Owners / Crew Agency
O/S / ANDOR / General Cargo\
2516 / Liberia / 20.06.2013 / 31.03.2014 / Water Bird Shiping LTD / Marine Star
O/S / CREDO / Dry Cargo\3135 / Liberia / 13.08.2014 / 23.12.2014 / Fapiola Shipping / Fapiola Shipping
O/S / THIRA / Container Carrier\28370.3 / Monrovia / 09.02.2015 / 23.10.2015 / Venetion Co / Golden Port
O/S / Mol Generosity / Container
Ship\59176 / Monrovia / 18.09.2016 / 20.03.2017 / Dohle Peter Schiffahrts / Marine Management Shipping Ukraine

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