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APPLICATION FORM |
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| Name: Sergey | Surname: Berezin | ||||||
| Date of birth: 04.12.1984 | Place of birth: Sevastopol | ||||||
| Permanent address: Sevastopol, Ukraine | |||||||
| Passport (OVIR): AK 672556 | Place of issue: Sevastopol | Date of issue: 07.04.2005 | Valid until: 07.04.2015 | ||||
| Seaman’s book: AB 320745 | Place of issue: Sevastopol | Date of issue: 10.10.2006 | Valid until: 26.09.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Berezina Galina | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Sevastopol Marine College | AB | . | 26.06.2004 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00216/2005/10 |
Sevastopol |
11.03.2005 |
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| Endorsement STCW |
00216/2005/10 |
Sevastopol |
11.03.2005 |
27.08.2009 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
64920C |
Sevastopol |
27.08.2004 |
28.08.2009 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
0539/2006 |
Sevastopol |
25.10.2006 |
25.10.2011 |
Sea service (during five last years):
|
Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| Shelly |
Caspi cargo |
3500 |
Slovakia |
. |
AB |
30.10.2006 |
23.02.2007 |
| Frio Oceanic |
Laskaridis Shipping |
5820 |
Panama |
. |
AB |
20.08.2007 |
23.04.2008 |
| 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: 14.08.2017 | |||
Ready to work from: any time