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APPLICATION FORM

 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

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

00101/2007/11

Kherson

29.03.2007

---

 Endorsement STCW

00101/2007/11

Kherson

29.03.2007

---

 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):

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

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