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APPLICATION FORM |
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| Name: Dmytro | Surname: Avramenko | ||||||
| Date of birth: 17.11.1987 | Place of birth: Kherson | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): PO 820621 | Place of issue: Kherson | Date of issue: 03.03.2007 | Valid until: 03.03.2017 | ||||
| Seaman’s book: AB 324876 | Place of issue: Kherson | Date of issue: 10.01.2007 | Valid until: 10.01.2012 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Avramenko Luybov | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Kherson Maritime Institute | . | . | 3-rd course | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00101/2007/11 |
Kherson |
29.03.2007 |
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| Endorsement STCW |
00101/2007/11 |
Kherson |
29.03.2007 |
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| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
100101/06 KH |
Kherson |
30.11.2006 |
30.11.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
6507/06 KH |
Kherson |
17.11.2006 |
17.11.2011 |
Sea service (during five last years):
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Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| Bagerovo |
Seabell |
500 |
Ukraine |
Reefer |
Cadet |
29.05.2006 |
29.05.2006 |
| Montana |
Nautilus |
17127.4 |
Ant&Barb |
Cont |
Cadet |
17.09.2007 |
19.03.2008 |
| Experience at sea: Since 2006 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 2017 | |||
Ready to work from: any time