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APPLICATION FORM

 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  -  -

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

01158/2005/08

Odessa

05.07.2005

--

 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

--

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

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