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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

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