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APPLICATION FORM

 

 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

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):

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

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