APPLICATION FORM

Name: Eduard		Surname: Krutous	Father’s name: Anatoliy
Date of birth: 02.02.1966		Place of birth: Odessa	Personal Code: 2413901519
Permanent address: Odessa, Ukraine
Passport (OVIR): AT 695393	Place of issue: Odessa	Date of issue: 14.08.2001	Valid until: 14.08.2011
Seaman’s book: AB 333600	Place of issue: Odessa	Date of issue: 21.06.2005	Valid until: 21.06.2010
Citizenship: Ukrainean		Expiry date of U.S. visa: NO
Marital Status		Married
Next of kin: (name, pas. No)		wife - Krutous Svitlana - KE 684957
Supported children under age of 18		- Krutous Olena - 1989
(name, surname, date of birth)		-
Knowledge of English language		Fair
Education:	Qualification:	No Diploma	Date of Issue
Odessa Maritime School	AB	104	17.02.1994

Certificates of STCW 78/95	No.	Place	Date of issue	Expiry date
Certificate of competency (Seaman)	01063/2004/08	Odessa	22.04.2004	-
Endorsement STCW	01063/2004/08	Odessa	22.04.2004	22.04.2009
Personal Sea Survival (ÁÆÑ)(A-VI/1)	LZ 61491B	Odessa	02.04.2004	02.04.2009
Carrying dangerrous & hazardous cargo (B-V/4, B-V/5)	11765B	Odessa	06.04.2004	06.04.2009
Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2)	LZ 45429B	Odessa	02.04.2004	02.04.2009
Ro-Ro passenger ships (VI/4-1)	06638B	Odessa	13.12.2005	13.12.2010
Hazardous Cargoes (B-V/4 B/5)	LZ 11769B	Odessa	06.04.2004	06.04.2009

Name of vessel	COMPANY	HP/DWT	Flag	Type	Position	From	To
Elwwod	Novvelle MT	2717/3575	Panama	Dry Cargo	AB	08.2005	11.2005
Vanda	Seahope Nav.	1600/2435	Comoros	Dry Cargo	AB	06.2004	05.2005
Briz	USCES	5000	Ukraine	Pass	Carpenter	13.04.2003	17.09.2004
Passat	GESS & Co	5000	Ukraine	Pass	Carpenter	01.08.2001	16.05.2002
G. Ushakov	USCES	6000	Ukraine	Pass	Carpenter	03.08.2000	20.06.2001

Experience at sea:  from 1994		Knowledge Personal Computer: NO
Medical Certificate	¹	Issued:	Place:	Exp. date:
Vaccination for cholera valid until:		Vaccination for yellow fever valid until: 10.08.2015

Ready to work from:   any time