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APPLICATION FORM |
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| Name: Illya | Surname: Konopatsky | ||||||
| Date of birth: 21.01.1985 | Place of birth: Sevastopol | ||||||
| Permanent address: Sevastopol, Ukraine | |||||||
| Passport (OVIR): EC 796783 | Place of issue: Sevastopol | Date of issue: 06.11.2006 | Valid until: 06.11.2016 | ||||
| Seaman’s book: AB 320301 | Place of issue: Sevastopol | Date of issue: 16.08.2006 | Valid until: 15.03.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Konopatskaya Alina | ||||||
| Supported children under age of 18 | Konopatsky Nikita, 21.10.2007 | ||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Sevastopol Marine Training Centre | OS | 2006 | |||||
| Kherson National Maritime University | Navigator | now studying | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00840/2006/01 |
Sevastopol |
11.10.2006 |
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| Endorsement STCW |
00840/2006/11 |
Sevastopol |
11.10.2006 |
11.10.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
04444C |
Sevastopol |
04.08.2006 |
05.08.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
0363/2009 |
Sevastopol |
18.03.2009 |
18.03.2014 |
| Antigua Seaman's book |
81217 |
Antigua |
24.06.2008 |
23.06.2013 |
Sea service (during five last years):
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Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| Bukanier |
Briese |
2300 |
Gibraltar |
Dry cargo |
cadet |
05.2007 |
09.2007 |
| BBC Sweden |
Briese |
4300 |
Gibraltar |
Multipurp |
OS |
10.2007 |
04.2008 |
| BBC Ems |
Briese |
17500 |
St.Johns |
Multipurp |
OS |
06.2008 |
12.2008 |
| BBC Austria |
Briese |
7700 |
St.Johns |
Heavy lift |
OS |
03.2009 |
09.2009 |
| Experience at sea: Since 2007 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 2015 | |||