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APPLICATION FORM

 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

 Certificates of STCW 78/95

 No.

 Place

 Date of issue

 Expiry date

 Certificate of competency  00241/2007/06  Mariupol

22.11.2007

---

 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):

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

 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

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