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APPLICATION FORM
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| Name: KOSTANTYN | Surname: PALASH | Father’s name: EDUARD |
| Date of birth: 17.03.1981 | Place of birth: ODESSA | Personal Code: |
| Permanent address: ODESSA, UKRAINE |
| Passport (OVIR): KC 199299 | Place of issue: Odessa | Date of issue: 28.11.1999 | Valid until: 28.11.2009 |
| Seaman’s book: AB 137807 | Place of issue: Odessa | Date of issue: 21.10.1999 | Valid until: 21.10.2004 |
| Citizenship: Ukrainean | Expiry date of U.S. visa: NO |
| Marital Status | Married |
| Next of kin: (name, pas. No) | wife - Palash Juliya - Pass. KM 200693 |
| Supported children under age of 18 | no |
| (name, surname, date of birth) | - |
| Knowledge of English language | Good |
| Education: | Qualification: | No Diploma | Date of Issue |
| College: | AB | KC 003031 | 06.1999 |
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00154/2004/03 |
Odessa |
13.02.2004 |
13.02.2009 |
| Endorsement STCW |
00154/2004/03 |
Odessa |
13.02.2004 |
13.02.2009 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) |
0047/2004 |
Odessa |
16.01.2004 |
16.01.2009 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2-1,2) |
0213/2004 |
Odessa |
29.01.2004 |
29.01.2009 |
| Hazardous cargo |
0117/2004 |
Odessa |
27.01.2004 |
27.01.2009 |
| Breathing apparatus |
0126/2004 |
Odessa |
27.01.2004 |
27.01.2009 |
| Advansed fire fighting |
0069/2004 |
Odessa |
26.02.2004 |
26.02.2009 |
| Tankerman Certificate (Oil/Chemical/LPG) (Advanced and Familiarisation A-V/1, p.2-7) |
0044/2004 |
Odessa |
29.01.2004 |
29.01.2009 |
Sea service (during five last years):
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Name of vessel |
COMPANY |
HP/DWT |
Flag |
Type |
Position |
From |
To |
| Diamand H | Green Way LTD |
16000 t. |
Cyprus |
bulker |
Kadet |
28.06.1998 |
10.05.1999 |
| Genichesk | CHERAZMORPUT |
1656 p.t. |
Ukr |
Bucket Dredger |
AB |
02.06.2000 |
24.04.2001 |
| Genichesk | CHERAZMORPUT |
1656 p.t. |
Ukr |
Bucket Dredger |
AB |
20.07.2001 |
25.04.2002 |
| B. Grushin | CHERAZMORPUT |
2081 |
Ukr |
Bucket Dredger |
AB |
17.12.2002 |
23.08.2003 |
| Experience at sea: from 1999 | Knowledge Personal Computer: YES |
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: |
Ready to work from: ANY TIME