APPLICATION FORM
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APPLICATION FORM |
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| Name: | Oleksandr | ||||
| Surname: | Sakun | ||||
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Date of Birth: |
06.10.1979 | ||||
| Place of Birth: | Berdiansk, Ukraine | ||||
| Permanent address: | Berdiansk, Ukraine | ||||
| Phone: | +380-6153-51800; mob: +380-67-7107334 | ||||
| Personal code: | 2913317017 | ||||
| Citizenship: | Ukraine | ||||
| Passport No.: | AT 284695 | ||||
| Date of issue: | 01.10.2002 | ||||
| Place of issue: | Berdiansk | ||||
| Valid untill: | 01.10.2012 | ||||
| Seaman's Book No.: | AB 120856 | ||||
| Date of issue: | 30.04.1998 | ||||
| Place of issue: | Odessa | ||||
| Valid untill: | 11.12.2004 | ||||
| Expiry date of U.S. visa: | NO | ||||
| vaccination valid untill for cholera: | - | ||||
| vaccination valid untill for yellow fever: | 19.11.2012 | ||||
| Date of last medical certificate: | - | ||||
| Marital status: | Married: | Single: X | Divorced: | Widower: | |
| Next of kin: (name, pas. No) | mother | ||||
| Supported children under | NO | ||||
| age of 18 (name, surname, date of birth) | - | ||||
| Knowledge of English language: | Very good: | Good: | Satisfactory: X | Fair | Poor: |
Licences, grades, certificates:
|
Licence held/grade, certificate |
No. |
Authority |
Country |
Date of issue |
Expiry date |
| Cert. of competency 3-rd class Eng. |
521/2002 |
Harbour Master |
Ukraine |
25.04.02 |
25.04.07 |
| Endorsement |
521/2002 |
port of Odessa |
Ukraine |
07.05.2002 |
26.02.07 |
| Survival craft |
29990 |
"TRAINING AND CERTIFYING |
Ukraine |
13.09.02 |
13.09.07 |
| Fire Fighting |
27311 |
CENTRE SURVIVAL AT SEA |
Ukraine |
13.09.02 |
13.09.07 |
| Medical first aid |
19165B |
OF ODESSA" |
Ukraine |
30.09.02 |
30.09.07 |
Sea service (during five last years):
|
Name of vessel |
Company |
HP/DWT |
Flag |
Type |
Position |
From |
To |
| Professor Pavlenko | OSMA |
5500/6127 |
Ukraine |
cargo |
cadet |
11.05.98 |
19.08.98 |
| Hadjibey | Odessa port |
2+570/658 |
Ukraine |
Passeng. |
cadet |
09.07.01 |
19.12.01 |
Ready to work from: ANY TIME