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APPLICATION FORM

 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

 Certificates of STCW 78/95

 No.

 Place

 Date of issue

 Expiry date

 Certificate of competency  00874/2007/07  Odessa

23.07.2007

---

 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):

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

 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

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