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APPLICATION FORM

 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 

 Certificates of STCW 78/95

 No.

 Place

 Date of issue

 Expiry date

 Certificate of competency  00080/2004/09  Sevastopol

14.06.2004

---

 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):

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

 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

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