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APPLICATION FORM |
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| Name: Vladyslav | Surname: Glinsky | ||||||
| Date of birth: 15.10.1973 | Place of birth: Ukraine | ||||||
| Permanent address: Sevastopol, Ukraine | |||||||
| Passport (OVIR): AK 003534 | Place of issue: Sevastopol | Date of issue: 10.08.2004 | Valid until: 10.08.2014 | ||||
| Seaman’s book: AB 037155 | Place of issue: Sevastopol | Date of issue: 29.06.2004 | Valid until: 29.06.2009 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | . | ||||||
| Supported children under age of 18 | Anastasia Glinskaya, 14.03.2005 | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Fair | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Sevastopol National Tech University | motorman | 087909 | 16.04.2004 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00080/2004/09 | Sevastopol |
14.06.2004 |
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| Endorsement STCW | 00080/2004/09 | Sevastopol |
14.06.2004 |
16.04.2009 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 60411C | Sevastopol |
16.04.2004 |
17.04.2009 |
| Advanced Fire Fighting (A-VI/3) | 33830C | Sevastopol |
18.03.2005 |
19.03.2010 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 53546C | Sevastopol |
18.03.2005 |
19.03.2010 |
| Medical First Aid (A-VI/4-1) | 29400C | Sevastopol |
18.03.2005 |
19.03.2010 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Proliv Victoria | Status Shipping S.A. |
10600 |
Ukraine |
Reefer |
motorman |
29.06.2004 |
29.09.2004 |
| Blue Ice | AFK Universal consulting Ltd |
3514 |
Morony |
Refrig |
motorman |
23.03.2007 |
17.07.2007 |
| Blue Ice | AFK Universal consulting Ltd |
3514 |
Morony |
Refrig |
motorman |
26.06.2008 |
10.12.2008 |
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Experience at sea: Since 2004 |
Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate # 10824 | Issued: 12.03.2007 | Place: Sevastopol | Exp.date: 12.03.2008 | |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 18.12.2014 | |||
Ready to work from: 15.03.2009