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APPLICATION FORM

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                               APPLICATION FORM

                                                                                                                                    

 

Personal Details

Rank:

Able Seaman

Nationality:

Ukraine

First Name:

Maksym

Surname:

Hmelyov

Father’s Name:

Igorevich

Requested Salary:
Date of birth:

18. 05. 1989

Place of birth:

Ukraine/Chernomorsk

Telephone: Nearest Airport:

Odessa

 
Mobile Phone: Weight (Kg): Shoes size:  
E-mail:

Maksim1989@ua. fm

Height (Cm): Overall size:  
Smoker: Yes

(Y) Yes or (N) No

 Marital Status:             Married No. of children:  
Skype Address:    
Home Address:

Ukraine/Chernomorsk/Street Sredniya ap. 16

 

Knowledge of English language (1-5):         

  

1. Very good 2. Good 3. Satisfactory + 4. Fair 5. Poor

  

Knowledge of Personal Computer (1-5):         

  

1. Very good 2. Good + 3. Satisfactory 4. Fair 5. Poor

  
                 

Next of Kin

Surname: Hmelyova Name: Aleksandra
Relationship: Wife Telephone:
Home Address:

Ukraine/Chernomorsk/Street Sredniya ap/16

 

Travel Documents Number Place of Issue Issued on Expires on
Travel Passport: EA268997 Odessa 26. 09. 2007 26. 09. 2017
Seaman’s Book: AB570085 Odessa 28. 03. 2016 28. 03. 2021
National Passport: KM327355 Chernomorsk 19. 08. 2005  
Schengen Visa: / US Visa:        

 

Name of Marine School Attended Qualification or Diploma From To
Odessa national academyof law school 3 Sailor/motorman 1. 09. 2004 27. 06. 2007
Training center of seafarers AVANT Able Seaman 23. 04. 2013 24. 07. 2013
License(s) Held

Limitation(s) on GRT (if any)

Grade/Class of license

 
   
  Number

Place of Issue

Issued on

Expires on

     
             
STCW Certificates Number Place of Issue Issued on

Expires on

Certificate of competency OOW II/1 12683/2015/08 Ukraine 06. 07. 2015
Endorsement STCW      
Basic Safety Training (A-VI/1) 14 083 Odessa 27. 01. 2017

27. 01. 2022

Engine Team and Resource Management      
GMDSS Gen. Operator Certificate (A-IV/2)      
GMDSS Gen. Operator Endorsement (A-IV/2)      
Radar Observation and Plotting (A-II/1, 2)      
Automatic Radar Plotting Aids (ARPA) (A-II/1, 2)      
Prof. in Survival Craft& Rescue Boats (A-VI/2-1) 8 509 Odessa 27. 01. 2017

27. 01. 2022

Prof. in Fast Rescue Boats (A-VI/2-2)      
Advanced Fire Fighting (A-VI/3) 10385/2015-A Odessa 09. 06. 2015

09. 06. 2020

Medical First Aid (A-VI/4-1)      
Ship’s Medical Care (A-VI/4-2)      
Ship Security Officer SSO (VI/5)      
Ship Safety Officer          
Dangerous & hazardous cargo (B-V/4, B-V/5)      
Security related training and instruction for all seafarers A-6/VI-1      
Designated security duties of shipboard personnel A-VI/6-2 Odessa 03. 09. 2014

03. 09. 2019

Ro-Ro passenger ships (A-V/2)      
Other than Ro-Ro passenger ships (A-V/3)      
Electronic Chart Display & Information System      
Tanker Certificates Number Place of Issue Issued on Expires on
Oil Tanker familiarization (A-V/1, 2-7)        
Oils Tanker advanced (A-V/1, 9-14)        
Chemical Tanker familiarization (A-V/1, 2-7)        
Chemical Tanker advanced (A-V/, 16-21)        
LPG familiarization (A-V/1, 2-7)        
LPG advanced (A-V/1, 23-34)        
Crude oil washing        
Inert gas system        
Bridge Team Management        
Specialized Oil Training        
Specialized Chemical Training        
Specialized LPG Training        
Special Training Certificates Number Place of Issue Issued on Expires on
DP Induction/Basic course        
DP Advanced/Simulator course        
DP Unlimited        
DP Maintenance (for engineers)        
BOSIET        
Helicopter Underwater Escape Training (HUET)        
Helicopter Landing Officer (HLO)        
H2S Training        
Fast Rescue Boats        
Maintenance of Electrical and Electronic Engineering        
Medical Certificates Number Place of Issue Issued on Expires on
Physical Examination Odessa 1. 06. 2016 1. 06. 2017
Yellow Fever Vaccination Odessa 20. 02. 2008 20. 02. 2018
Drug and alcohol test Odessa 1. 06. 2016 1. 06. 2017

Previous Sea Service (Please start with last contracts)

#

From

To

Vessel

Type

Flag

DWT

M/E Position

Company

20. 02. 09

23. 07. 09

 AKSOY

Dry Cargo

 Liberia 2-1320 Able Seaman

Almagest
23. 01. 12

04. 06. 12

 Odessit

Dry Cargo

 Moldova 2-515 Able Seaman

Eurobulk
29. 09. 12

6. 04. 13

 Volgo Balt 242

Dry Cargo

 Moldova 2-700 Seaman

Eurobulk
13. 11. 13

22. 01. 14

 Leo V

General Cargo

 Moldova Able Seaman

Eurobulk
9. 11. 14

27. 05. 15

 Odessit

Dry Cargo

 Moldova 2-515 Able Seaman

Eurobulk

 

 

 

 

 

 

 

   

 

28. 09. 15

23. 01. 16

 Hermes

General Cargo

 Moldova Able Seaman

Eurobulk
12. 06. 16

03. 10. 16

 Syatogor

General Cargo

 Zanzibar 2-883 Able Seaman

Eurobulk
05. 11. 16

8. 01. 17

 Anna-Meta

Bulk Carrier

 Liberia   Able Seaman

Ukraine
 

 

 

 

 

 

   

 

References

   
#

Name of company

Address

Contact person

e-mail

Tel No    

 

 

 

 

     

 

 

 

 

     

 

 

 

 

     
                                 

 


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