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APPLICATION FORM

 Name: Andriy  Surname: Monastyrsky
 Date of birth: 12.05.1979  Place of birth: Ukraine
 Permanent address: Belgorod-Dnestrovsky, Odessa reg., Ukraine
 Passport (OVIR): AT 69061  Place of issue: Odessa  Date of issue: 05.07.2001  Valid until: 05.07.2011
 Seaman’s book: AB 02897  Place of issue: Sevastopol  Date of issue: 03.09.1999  Valid until: 23.04.2009
 Citizenship: Ukraine  Expiry date of U.S. visa: 19.04.2010
 Marital Status  Single
 Next of kin: (name, pas. No)  .
 Supported children under age of 18  .
 (name, surname, date of birth)  .
 Knowledge of English language  Satisfactory
 Education:  Qualification:  No Diploma:  Date of Issue:
 B-Dnestrovsky Fish Maritime Industrial College   Technician-Mechanic  .  2001

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

001333

Odessa

10.02.2006

---

 Endorsement STCW

00257

Odessa

09.03.2006

02.03.2011

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

LZ 61755B

Odessa

22.04.2004

22.04.2009

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

00257

Odessa

09.03.2006

02.03.2011

 Carrying dangerous & hazardous cargo (B-V/4, B-V/5) 

LZ 15503B

Odessa

03.12.2004

03.12.2009

 Advanced Fire Fighting (A-VI/3) 

LZ 38204B

Odessa

08.02.2006

08.02.2011

 Cyprus Seaman's book 

CY 083120

Cyprus

06.07.2005

05.07.2015

Sea service (during five last years):

Name of vessel

COMPANY

DWT

Flag

Type

Position

From

To

 Are

 Sartoria Co S.A.

15893

Malta

Lo-Ro

OS

22.06.2004

06.11.2004

 Atlantic Action 

 Elanio Shipping Co

17670

Cyprus

Lo-Ro

OS

05.05.2005

15.10.2005

 Atlantic Leader 

 Frontenac International S.A.

15893

Malta

Lo-Ro

AB

23.06.2006

09.10.2006

 Mekong Spirit 

 Starlio Shipping Co Ltd

14000

Cyprus

Container

AB

21.01.2007

25.07.2007

 Experience at sea: Since 1999  Knowledge Personal Computer (Yes / No): Yes 
 Medical Certificate  ¹  Issued:    Place:  Exp.date:
 Vaccination for cholera valid until:  Vaccination for yellow fever valid until: 03.09.2009 

Ready to work from:  any time

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