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APPLICATION FORM

 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

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

00216/2005/10

Sevastopol

11.03.2005

---

 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

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