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APPLICATION FORM

 Name: Oleksandr  Surname: Bakuta
 Date of birth: 03.01.1987  Place of birth: Crimea, Ukraine
 Permanent address: Yalta, Ukraine
 Passport (OVIR): EC 620371  Place of issue: Yalta  Date of issue: 03.07.2006  Valid until: 03.07.2016
 Seaman’s book: AB 390669  Place of issue: Sevastopol  Date of issue: 21.08.2008  Valid until: 28.07.2013
 Citizenship: Ukraine  Expiry date of U.S. visa: NO
 Marital Status  Single
 Next of kin: (name, pas. No)  Bakuta Lubov
 Supported children under age of 18  .
 (name, surname, date of birth)  .
 Knowledge of English language  Fair
 Education:  Qualification:  No Diploma:  Date of Issue:
 Sevastopol Vocational School   motorman  .  13.07.2008

 Certificates of STCW 78/95

 No.

 Place

 Date of issue

 Expiry date

 Certificate of competency  014813  Sevastopol

13.07.2008

---

 Endorsement STCW  00285/2008/10  Sevastopol

01.08.2008

29.01.2013

 Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1)  0138/2008  Sevastopol

29.01.2008

29.01.2013

 Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2)  0107/2008  Sevastopol

30.01.2008

30.01.2013

 Passenger ships other than Ro-Ro (A-V/3)  0024/2008  Sevastopol

01.02.2008

01.02.2013

Sea service (during five last years):

Name of vessel

Company

DWT

Flag

Type

Position

From

To

 Upiter  Port of Sevastopol  .  Ukraine  Passenger  OS/motorman

14.02.2008

14.06.2008

 Geroi Sevastopolya   Sudostroenie  1765  Ukraine  Passenger  Motorman

09.09.2008

12.11.2008

 Experience at sea: Since 2008

 Knowledge Personal Computer (Yes / No): Yes 
 Medical Certificate # 7136  Issued: 17.11.2008  Place: Odessa  Exp.date: 17.11.2009
 Vaccination for cholera valid until:  Vaccination for yellow fever valid until: 09.09.2018 

Ready to work from:  any time

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