APPLICATION FORM

 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

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

00840/2006/01

Sevastopol

11.10.2006

---

 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):

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