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APPLICATION FORM |
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| 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 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 014813 | Sevastopol |
13.07.2008 |
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| 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):
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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 |
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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