|
|
APPLICATION FORM |
|
| Name: Andriy | Surname: Chernenko | ||||||
| Date of birth: 21.12.1972 | Place of birth: Odessa reg. | ||||||
| Permanent address: Izmail, Odessa reg., Ukraine | |||||||
| Passport (OVIR): EC 63659 | Place of issue: Odessa | Date of issue: 10.10.2006 | Valid until: 10.10.2016 | ||||
| Seaman’s book: AB 342516 | Place of issue: Odessa | Date of issue: 16.10.2006 | Valid until: 16.10.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | . | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa Marine School | motorman | 2018 | 12.06.2000 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00860/2006/08 | Odessa |
07.12.2006 |
--- |
| Endorsement STCW | 00860/2006/08 | Odessa |
07.12.2006 |
06.11.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 1/806/06 | Illichivsk |
06.11.2006 |
06.11.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 08584U | Izmail |
09.11.2006 |
09.11.2011 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Ochakov | Ukrrechflot |
993 |
Ukraine |
Dry cargo |
motorman |
15.07.2004 |
06.09.2005 |
| Michail Mimis | Nideir Maritime Inc. |
6994.45 |
St. Vencent |
Gen cargo |
motorman |
13.02.2007 |
08.10.2007 |
|
Experience at sea: Since 2000 |
Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | Issued: | Place: | Exp.date: | |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 08.12.2006 | |||
Ready to work from: any time