APPLICATION FORM
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APPLICATION FORM |
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| Name: | Anatoliy | ||||
| Surname: | Babchenko | ||||
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Date of Birth: |
24.10.1963 | ||||
| Place of Birth: | Odessa, Ukraine | ||||
| Permanent address: | Ilyichevsk, Odessa reg., Ukraine | ||||
| Personal code: | 2330706837 | ||||
| Citizenship: | Ukraine | ||||
| Passport No.: | AE 638956 | ||||
| Date of issue: | 09.06.1997 | ||||
| Place of issue: | Ilyichevsk, Ukraine | ||||
| Valid untill: | 09.06.2007 | ||||
| Seaman's Book No.: | AB 082522 | ||||
| Date of issue: | 14.08.2002 | ||||
| Place of issue: | port of Illichevsk | ||||
| Valid untill: | 14.08.2007 | ||||
| Expiry date of U.S. visa: | NO | ||||
| vaccination valid untill for cholera: | 17.03.2000 | ||||
| vaccination valid untill for yellow fever: | - | ||||
| Date of last medical certificate: | - | ||||
| Marital status: | Married: X | Single: | Divorced: | Widower: | |
| Next of kin: (name, pas. No) | Babchenko Natalia - KK 109393 | ||||
| Supported children under | Babchenko Vadim - 05.07.1989 | ||||
| age of 18 (name, surname, | Babchenko Evgeniy - 20.03.1998 | ||||
| date of birth) | - | ||||
| Knowledge of English language: | Very good: | Good: X | Satisfactory: | Fair: | Poor: |
| Other language knowledge: | Greek | ||||
Licences, grades, certificates:
|
Licence held/grade, certificate |
No. |
Authority |
Country |
Date of issue |
Expiry date |
| Proficiency in Survival Craft |
19954 |
"TRAINING AND CERTI - |
Ukraine |
29.03.2000 |
29.03.2005 |
| Tankerman Certificate |
0188/2002 |
- FYING CENTRE |
Ukraine |
31.05.2002 |
31.05.2007 |
| Ship's welder |
0436/2003 |
SURVIVAL AT SEA |
Ukraine |
18.06.2003 |
18.06.2005 |
| STCW |
1541/2002 |
OF ODESSA" |
Ukraine |
23.05.2002 |
23.05.2007 |
Sea service (during five last years):
|
Name of vessel |
Company |
HP/DWT |
Flag |
Type |
Position |
From |
To |
| Asphalt Leader | Chromos Ship |
35265 |
Greece |
tanker |
fitter-welder |
08.96 |
02.97 |
| Mathildaki | Panorama |
37616 |
Malta |
bulker |
fitter-welder |
10.06.97 |
16.11.97 |
| Almavita | Shipping Co |
45550 |
Cyprus |
bulker |
fitter-welder |
05.01.98 |
02.08.98 |
| Higland Trast | Prime Marine |
42838 |
Panama |
bulker |
fitter-welder |
10.11.98 |
07.08.99 |
| Mindas | Prime Marine |
75714 |
Panama |
OBO |
fitter-welder |
27.11.99 |
15.02.00 |
| Mindas | Prime Marine |
75714 |
Panama |
OBO |
fitter-welder |
31.03.00 |
29.12.00 |
| Grouper | Prime Marine |
149863 |
Miami |
OBO |
fitter-welder |
23.05.01 |
02.02.02 |
| Panter | Prime Marine |
45000 |
Miami |
tanker |
fitter-welder |
20.10.02 |
15.06.03 |
Ready to work from: ANY TIME