APPLICATION FORM
|
APPLICATION FORM |
|
| Name: | Yuriy | ||||
| Surname: | Bebel | ||||
|
Date of Birth: |
29.10.1966 | ||||
| Place of Birth: | Odessa, Ukraine | ||||
| Permanent address: | Odessa, Ukraine | ||||
| Personal code: | 2440807677 | ||||
| Citizenship: | Ukraine | ||||
| Passport No.: | AH 590369 | ||||
| Date of issue: | 27.07.1998 | ||||
| Place of issue: | Odessa | ||||
| Valid untill: | 27.07.2008 | ||||
| Seaman's Book No.: | AB 142237 | ||||
| Date of issue: | 06.04.2000 | ||||
| Place of issue: | Odessa | ||||
| Valid untill: | 07.10.2009 | ||||
| Expiry date of U.S. visa: | NO | ||||
| vaccination for cholera valid untill: | - | ||||
| vaccination for yellow fever valid untill: | 30.07.2011 | ||||
| Date of last medical certificate: | 16.08.2002 | ||||
| Marital status: | Married: X | Single: | Divorced: | Widower: | |
| Next of kin: (name, pas. No) | wife - Bebel Maria KE 750138 | ||||
| Supported children under age of 18 | 1. daughter - Bebel Yulia 01. 06. 1990 | ||||
| (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 cert. |
00122 |
Odessa Harb. Master |
Ukraine |
30.08.2002 |
30.08.2007 |
| Endorsement cert. |
00122 |
Training |
Ukraine |
30.08.2002 |
30.08.2007 |
| Personal Sea Survival |
36912 |
Simulator ship |
Ukraine |
15.08.2002 |
15.08.2007 |
| Proficiency in survival craft |
26312 |
"Lesozavodsk" |
Ukraine |
15.08.2002 |
15.08.2007 |
| Cyprus Seaman's book |
cy010453 |
Limasol |
Rep.of Cyprus |
23.05.2002 |
23.05.2012 |
Sea service (during five last years):
|
Name of vessel |
Company |
HP/DWT |
Flag |
Type |
Position |
From |
To |
| "D.Shostakovitch" | - |
4560x4/9478 |
Ukraine |
pass |
motorman |
08.1990 |
11.1998 |
| "Menelaos" | Tower Field ship company Limassol |
9900/14786 |
Cyprus |
mult-purpose |
oiler |
08.1999 |
03.2000 |
| "Fiori" | Ravello shipping company Ltd. |
G711kw/10478gr.t |
Cyprus |
universal |
oiler |
08.2001 |
05.2002 |
| "Wismar" | Castelbay Marine Group Inc.,Limassol |
11200/22886,6 |
Cyprus |
general cargo |
oiler |
10.2002 |
12.2002 |
| "Fiori" | Ravello shipping company Ltd. |
G711kw/10478gr.t |
Cyprus |
universal |
oiler |
14.05.2003 |
12.03.2004 |
Ready to work from: ANY TIME