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APPLICATION FORM

 Name: Andrey  Surname: Konopelko
 Date of birth: 24.09.1980  Place of birth: Moldova
 Permanent address: Odessa reg., Ukraine
 Passport (OVIR): AM 942489  Place of issue: Odessa  Date of issue: 09.11.2000  Valid until: 09.11.2010
 Seaman’s book: AB 07181324  Place of issue: Odessa  Date of issue: 24.10.2000  Valid until: 25.10.2009
 Citizenship: Ukraine  Expiry date of U.S. visa: 30.10.2011
 Marital Status  Married
 Next of kin: (name, pas. No)  wife - Konopelko Alla
 Supported children under age of 18  .
 (name, surname, date of birth)  .
 Knowledge of English language  Good
 Education:  Qualification:  No Diploma:  Date of Issue:
 Training center of seafarers AVANT   seamen  .  01.08.2013

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

04554/2003/08

Illichivsk

24.12.2003

---

 Endorsement STCW

04554/2003/08

Illichivsk

02.10.2008

02.10.2013

 Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1)

1/858/08

Illichivsk

01.08.2008

01.08.2013

 Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2)

1/151/08

Illichivsk

01.08.2008

01.08.2013

Sea service (during five last years):

Name of vessel

COMPANY

DWT

Flag

Type

Position

From

To

 Hill

 Aptera

23000

Liberia

Dry cargo

MB

14.03.2003

10.09.2003

 IMME

 Aptera

23000

Liberia

Dry cargo

OS

17.03.2004

29.08.2004

 Souria

 Tritea

17000

Cyprus

Bulker

OS

28.01.2005

22.06.2005

 Souria

 Larus

23000

Liberia

Bulker

AB

06.10.2005

09.09.2006

 Lake Michigan 

 Anglo-Eastern Group

38000

Marshall

Bulker

OS

19.12.2007

15.07.2008

 Experience at sea: Since 2002  Knowledge Personal Computer (Yes / No): Yes 
 Medical Certificate  ¹ 000040  Issued: 29.03.2002   Place: Odessa  Exp.date:
 Vaccination for cholera valid until:  Vaccination for yellow fever valid until:

Ready to work from:  17.10.2008

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