Application Form.		
																						
Position applied for:	motorman	2nd choice:	 	Min wage:	 		
Family Name	Ziblyuk	First name	Sergiy	Fathers name	Romanovich		
Date of Birth	22	12	1991	Place of Birth	Izmail. Ukraine	Nationality	ukranian		
Home address  	Ukrain. Odessa region.  Izmail. Street Repina 4 Flat 9		
Home phone nr.	53048	Contact/mobile phone number	0962431080	E-mail	
ht_91@mail.ru		
 		
LICENSES, PASSPORTS, CERTIFICATES, etc.		
Passports	Number	Date of Issue	Place	Valid Until		
Seaman’s Identification Card      	AB434239	08.09.2010	Ukranian,Izmail	08.09.2015		
Foreign Civil Passport      	EH532510	15.12.2010	Ukranian,Izmail	15.12.2020		
National Passport      	KM1522083	24.01.2008	Ukranian,Izmail	 		
Main Certificates  		
Certificate of Competency (Grade)	00271/2012/01	05.09.2012	Ukranian,Izmail	 		
Endorsement      	00271/2012/01	05.09.2012	Ukranian,Izmail	14.07.2015		
Certificate of Competency (Grade)	 	 	 	 		
Endorsement      	 	 	 	 		
Certificate of Competency (Grade)	 	 	 	 		
Endorsement      	 	 	 	 		
Other Certificates  		
Sec.A-VI/1 STCW-95 (Social responsibilities)      	07352U	14.07.2010	Ukranian,Izmail	14.07.15		
Sec.A-VI/2 STCW-95 (Proficiency in survival craft)      	15137U	17.07.10	Ukranian,Izmail	15.07.2015		
Sec.A-VI/3 STCW-95 (Advanced fire fighting)      	 	 	 	 		
Sec.B-V/4 & B-V/5 STCW-95 (Hazardous Cargoes)      	 	 	 	 		
Sec.A-VI/4-1 STCW95 (Medical first aid)      	 	 	 	 		
Sec.A-VI/4 STCW-95 (Medical Care)      	 	 	 	 		
Reg.V/1, 1.1,1.2; Sec.A-V/1, 1.7(Oil Tankers Famil.)      	1208U	27.07.2012	Ukranian,Izmail	27.07.2017		
Res.10 Sec.A-V/1, 9.14 (Adv.training Oil Tankers)      	 	 	 	 		
Reg.V/1, 1.STCW-95 (Breathing apparatus)      	 	 	 	 		
Res.11.12&16.34 Sec.A-V/1 (Chem Tank)      	 	 	 	 		
Res.11.12&16.34 Sec.A-V/1 (Liq Tank)      	 	 	 	 		
Res.11.12&16.34 Sec.A-V/1 (Gas Tank)      	 	 	 	 		
MARPOL 73/78 (Crude Oil Washing Certificate)      	 	 	 	 		
Reg.I/11, I/14 (Safety Officer Certificate)      	 	 	 	 		
Sec.II/2 STCW-95(Cert. rEvalidation Course)      	 	 	 	 		
Radar Observing Certificate      	 	 	 	 		
ARPA Certificate      	 	 	 	 		
Ship Security Officer Certificate  	 	 	 	 		
     	 	 	 	 		
     	 	 	 	 		
     	 	 	 	 		
     	 	 	 	 		
Foreign licences, seamen’s books and endorsements  		
seamans seagoing service record book	0078359	27.07.2010	Ukranian,Izmail	 		
     	 	 	 	 		
     	 	 	 	 		
     	 	 	 	 		
     	 	 	 	 		
Last 5 Employments		
 	Vsl Name	Owner	Flag	Rank	From	To	Vsl Type	Engine	DWT/BHP		
1	MARATHON	Western Marine transport	Niderland	motorman	25.11.2011	08.06.2012	cargo	bronz12gv-h	1125/1500hp		
2	MOSKOVSIY-8	Izmail sea trade port	Ukraine	motorman	06.05.2010	6.08.2010	tug	zylser	484		
3	 	 	 	 	11..05.2012	11.08	tug	zylser	500.4		
4	 	 	 	 	 	 	 	 	 		
5	 	 	 	 	 	 	 	 	 		
Last 3 Employers Full Style		
 	 Owner / Operator	Telephone	Fax	E-mail		
1	 	 	 	 		
2	 	 	 	 		
3	 	 	 	 		
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