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APPLICATION FORM |
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| Name: Denys | Surname: Gutsu | ||||||
| Date of birth: 17.05.1986 | Place of birth: Mariupol | ||||||
| Permanent address: Mariupol, Ukraine | |||||||
| Passport (OVIR): EA 079756 | Place of issue: Mariupol | Date of issue: 27.07.2007 | Valid until: 27.07.2017 | ||||
| Seaman’s book: AB 384864 | Place of issue: Mariupol | Date of issue: 31.10.2007 | Valid until: 31.102012 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | . | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Azov Safety Training Center | Fitter-welder | . | 2007 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00241/2007/06 | Mariupol |
22.11.2007 |
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| Endorsement STCW | 00241/2007/06 | Mariupol |
22.11.2007 |
09.10.2012 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 14906-AS | Mariupol |
09.10.2007 |
09.10.2012 |
| Cyprus Seaman's book | CY 121912 | Limassol |
28.02.2008 |
27.02.2018 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Carina II | Fanter Shipping Ltd | 17000 | Cyprus | Bulk carrier |
Welder |
09.02.2008 |
04.07.2008 |
| Katya Z | Shipping Co Ltd | 6049 | St.Vincent | Dry cargo |
Fitter-welder |
20.09.2008 |
11.12.2008 |
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Experience at sea: Since 2008 |
Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | Issued: | Place: | Exp.date: | |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 31.01.2018 | |||
Ready to work from: any time