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APPLICATION FORM |
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| Name: Yevgen | Surname: Beschetnov | ||||||
| Date of birth: 18.06.1988 | Place of birth: Izmail | ||||||
| Permanent address: Izmail, Odessa reg., Ukraine | |||||||
| Passport (OVIR): EA 840454 | Place of issue: Izmail | Date of issue: 01.04.2008 | Valid until: 01.04.2018 | ||||
| Seaman’s book: AB 343879 | Place of issue: Odessa | Date of issue: 28.12.2006 | Valid until: 28.12.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Beschetnova Liliya | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Marine Training Centre | motorman | . | 24.11.2006 | ||||
| Kherson Maritime College | electrician | . | 3 courses | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00874/2007/07 | Odessa |
23.07.2007 |
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| Endorsement STCW | 00874/2007/07 | Odessa |
23.07.2007 |
28.12.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 173294 | Izmail |
26.12.2006 |
26.12.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 094354 | Izmail |
28.12.2006 |
28.12.2011 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Sun Vita | Loe Marine Co Ltd |
1798 |
Malta |
Cargo |
Eng/deck Cadet |
10.11.2008 |
06.04.2009 |
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Experience at sea: Since 2008 |
Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate # 3233 | Issued: 07.11.2008 | Place: Odessa | Exp.date: 07.11.2009 | |
| Vaccination for cholera valid until: | Vaccination for yellow fever | |||
Ready to work from: any time