APPLICATION FORM
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APPLICATION FORM |
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| Name: | Oleksandr | ||||
| Surname: | Bily | ||||
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Date of Birth: |
08.04.67 | ||||
| Place of Birth: | Odessa, Ukraine | ||||
| Permanent address: | Odessa, Ukraine | ||||
| Personal code: | 2456901238 | ||||
| Citizenship: | Ukraine | ||||
| Passport No.: | KC 185378 | ||||
| Date of issue: | 28.07.99 | ||||
| Place of issue: | Odessa, Ukraine | ||||
| Valid untill: | 28.07.09 | ||||
| Seaman's Book No.: | AB 056763 | ||||
| Date of issue: | 02.09.96 | ||||
| Place of issue: | Odessa, Ukraine | ||||
| Valid untill: | 05.06.06 | ||||
| Expiry date of U.S. visa: | 21.10.2008 | ||||
| vaccination for cholera valid untill: | - | ||||
| vaccination for yellow fever valid untill: | 13.09.96 | ||||
| Marital status: | Married: X | Single: | Divorced: | Widower: | |
| Next of kin: (name, pas. No) | wife - Kiselova Irina | ||||
| Supported children under age of 18 | 1. | ||||
| (name, surname, date of birth) | - | ||||
| Knowledge of English language: | Very good: | Good: | Satisfactory: | Fair X | Poor: |
Licences, grades, certificates:
|
Licence held/grade, certificate |
No. |
Authority |
Country |
Date of issue |
Expiry date |
| STCW-CODE ' 95 |
0102/2001 |
- |
Ukraine |
17.05.01 |
- |
| motorman certificate |
1601/2002 |
- |
Ukraine |
01.10.02 |
- |
| Qualified motorman certificate |
01130/2002/08 |
- |
Ukraine |
29.12.02 |
- |
| Endorsement |
01130/2002/08 |
- |
Ukraine |
29.12.02 |
- |
Sea service (during five last years):
|
Name of vessel |
Company |
HP/DWT |
Flag |
Type |
Position |
From |
To |
| "Kareliya" | Black Sea |
25000 |
Ukraine |
passenger |
motorman |
02.96 |
01.97 |
| "Shota Rustaveli" | Black Sea |
20000 |
Ukraine |
passenger |
motorman |
08.98 |
03.00 |
| "Alexander the Great" | Oberon Cruise Line Ltd. |
20000 |
Greece |
passenger |
motorman |
12.01 |
07.02 |
| "Taras Shevchenko" | Antarctick |
20000 |
Ukraine |
passenger |
motorman |
01.03 |
07.03 |
| "Alexandra"-1 | Danaos |
40000 |
Greece |
bulker |
motorman |
- |
06.04 |
Redy to work: ANY TIME