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APPLICATION FORM |
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| 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 | ||||
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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