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APPLICATION FORM |
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| Name: Dmytro | Surname: Syrachenko | ||||||
| Date of birth: 25.10.1962 | Place of birth: Ukraine | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AX 107696 | Place of issue: Odessa | Date of issue: 22.09.2002 | Valid until: 22.09.2012 | ||||
| Seaman’s book: AB 188268 | Place of issue: Odessa | Date of issue: 05.07.2000 | Valid until: 05.04.2010 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Chabanenko Lydmila # KK933355 | ||||||
| Supported children under age of 18 | 1. Sirachenko Danila 25.08.1999 | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Satisfacrory | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa Vocational School | A/B | - | - | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
01158/2005/08 |
Odessa |
05.07.2005 |
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| Endorsement STCW |
01158/2005/08 |
Odessa |
05.07.2005 |
09.06.2010 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
80024/2005 |
Odessa |
08.06.2005 |
08.06.2010 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
42533/2005 |
Odessa |
08.06.2005 |
08.06.2005 |
| Boatswain Certificate |
0092/2005 |
Odessa |
09.06.2005 |
09.06.2010 |
| Able seamen Certificate |
0564/2005 |
Odessa |
09.06.2005 |
09.06.2010 |
| Advanced Fire fighting (A-VI/1) |
38666/2005 |
Odessa |
08.06.2005 |
08.06.2010 |
| Carrying Dangerous & Hazardous Cargo (B-V/b; B-V/c) |
0463/2004 |
Odessa |
30.03.2004 |
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Sea service (during five last years):
|
Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Meridian |
Odessa - Port |
300 |
Ukraine |
Tug-boat |
A/B |
02.1997 |
10.2001 |
| 2. Wish |
Larus |
23442 |
Malta |
Bulker |
A/B |
06.2003 |
02.2004 |
| 3. Talos |
Seabirds |
15980 |
Bahamas |
Bulker |
Bosun |
05.2004 |
03.2005 |
| 4. Adrias |
Welland Shipmngmt |
7500 |
Panama |
Bulker |
Bosun |
04.2006 |
07.2006 |
| Experience at sea: Since 1988 | Knowledge Personal Computer (Yes / No): | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||
Ready to work from: any time