|
|
APPLICATION FORM |
|
| Name: Volodymyr | Surname: Garkusha | ||||||
| Date of birth: 24.05.1959 | Place of birth: Dnepropetrovsk Reg., Ukraine | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AK 258170 | Place of issue: Odessa | Date of issue: 27.12.2004 | Valid until: 27.12.2014 | ||||
| Seaman’s book: AB 117693 | Place of issue: Odessa | Date of issue: 26.09.1997 | V alid until: 26.09.2007 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Trubka Lyudmila | ||||||
| Supported children under age of 18 | -- | ||||||
| (name, surname, date of birth) | -- | ||||||
| Knowledge of English language | poor | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa Marine School | motorman | 1417 | 06.1984 | ||||
|
Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 040 IL |
Illichevsk |
19.09.2003 |
19.09.2008 |
| Endorsement STCW | 040 IL |
Illichevsk |
19.09.2003 |
19.09.2008 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 35234 |
Odessa |
13.01.2004 |
13.01.2009 |
| Crowd Management (A-V/3) | LZ 04148B |
Odessa |
19.06.2003 |
19.06.2008 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | LZ 36977B |
Odessa |
19.06.2003 |
19.06.2008 |
Sea service (during five last years):
|
Name of vessel |
COMPANY |
DWT/HP |
Flag |
Type |
Position |
From |
To |
| Taras Shevchenko |
Antarctica |
21000/21000 |
Ukraine |
passanger |
motorman |
1984 |
2004 |
| Experience at sea: Since 1984 | Knowledge Personal Computer (Yes / No): | |||
| Medical Certificate | Issued: 28.12.2004 | Place: Odessa | Exp.date: 28.12.2005 | |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||
Ready to work from: ANY TIME