APPLICATION FORM
|
|
APPLICATION FORM |
|
| Name: | Borys | ||||
| Surname: | Baranovsky | ||||
|
Date of Birth: |
30.11.1957 | ||||
| Place of Birth: | Kirovograd Region | ||||
| Permanent address: | Odessa, Ukraine | ||||
| Personal code: | 2115301274 | ||||
| Citizenship: | Ukraine | ||||
| Passport No.: | AE 680323 | ||||
| Date of issue: | 18.02.1998 | ||||
| Place of issue: | Odessa | ||||
| Valid untill: | 18.02.2008 | ||||
| Seaman's Book No.: | AB 119949 | ||||
| Date of issue: | 05.03.2003 | ||||
| Place of issue: | Odessa | ||||
| Valid untill: | 05.03.2008 | ||||
| Expiry date of U.S. visa: | no | ||||
| vaccin. for cholera valid untill: | no | ||||
| vaccin. for yellow fever untill: | 11.12.2008 | ||||
| Date of last medical certificate: | 20.06.2003 | ||||
| Marital status: | Married: | Single: | Divorced:X | Widower: | |
| Next of kin: (name, pas. No) | Son - Baranovsky Igor - pass. # AX 105512 | ||||
| Supported children under age of 18 | 1. NO | ||||
| (name, surname, date of birth) | . | ||||
| Knowledge of English language: | Very good: | Good: | Satisfactory:X | Fair | Poor: |
Licences, grades, certificates:
|
Licence held/grade, certificate |
No. |
Authority |
Country |
Date of issue |
Expiry date |
| Qualified motorman |
00765 |
OMTS |
Ukraine |
30.04.2003 |
30.04.2008 |
| Endorsement motorman |
00765 |
OMTS |
Ukraine |
30.04.2003 |
30.04.2008 |
|
Advanced fire-fighting, First-aid, Survival techniques |
29900 |
OMTS |
Ukraine |
28.03.2003 |
28.03.2008 |
| Proficiency in Survival Craft CTCW-CODE'95 |
32726 |
OMTS |
Ukraine |
28.03.2003 |
28.03.2008 |
|
Competence specified STCW A-VI/3 |
66822 |
OMTS |
Ukraine |
28.03.2003 |
28.03.2008 |
Sea service (during five last years):
|
Name of vessel |
Company |
HP/DWT |
Flag |
Type |
Position |
From |
To |
| Shadwan | Rad Sea |
10000 |
Egypt |
cargo |
motorman |
29.02.1999 |
30.07.1999 |
| Island | Navigation |
18000 |
Egypt |
cargo |
motorman |
10.02.2000 |
19.12.2000 |
| Kupiskis | Argo Sea Meritime |
7500/3500 |
Malta |
cargo |
motorman |
23.06.2003 |
13.11.2003 |
Ready to work from: ANY TIME