APPLICATION FORM
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APPLICATION FORM |
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| Name: Vyacheslav | Surname: Rudenko | ||||||
| Date of birth: 14.06.1966 | Place of birth: Odessa reg. | ||||||
| Permanent address: Izmail, Odessa reg., Ukraine | |||||||
| Passport (OVIR): AM 633787 | Place of issue: Izmail | Date of issue: 09.11.1998 | Valid until: 01.01.2012 | ||||
| Seaman’s book: AB 350276 | Place of issue: Izmail | Date of issue: 10.03.2006 | Valid until: 10.03.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Romanova Olga | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Izmail Marine School | Bosun | 12.11.1984 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
01228/2003/01 |
Izmail |
22.09.2003 |
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| Endorsement STCW |
01228/2003/01 |
Izmail |
23.01.2006 |
23.01.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
86912 U |
Izmail |
23.12.2005 |
23.12.2010 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
62516 U |
Izmail |
22.12.2005 |
22.12.2010 |
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Tanker Certificates |
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| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) |
10427 IZ |
Izmail |
21.01.2006 |
20.01.2011 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) |
10427 IZ |
Izmail |
21.01.2006 |
20.01.2011 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) |
10427 IZ |
Izmail |
21.01.2006 |
21.01.2011 |
Sea service (during five last years):
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Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| Bogdan |
Alfa Vector |
12350 |
Malta |
Bulker |
Bosun |
21.08.2005 |
20.03.2006 |
| Desna |
Udasco |
3309 |
Ukraine |
Tanker |
Bosun |
29.03.2006 |
06.10.2006 |
| Skif |
Uniship |
6072 |
St.Vincent |
Dry cargo |
Bosun |
09.01.2007 |
05.06.2007 |
| Fairplay |
Uniship |
3038 |
Dominica |
Dry cargo |
Bosun |
08.08.2007 |
12.01.2008 |
| Skif |
Alfa Vector |
6072 |
St.Vincent |
Dry cargo |
Bosun |
19.03.2008 |
16.08.2008 |
| Dorothea |
Uniship |
2240 |
St.Vincent |
Dry cargo |
Bosun |
07.11.2008 |
03.04.2009 |
| Experience at sea: Since 1987 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: 04.09.2009 | Place: Izmail | Exp.date: 04.09.2010 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||
Ready to work from: any time