APPLICATION FORM
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APPLICATION FORM |
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| Name: Vlades | Surname: Katauskas | ||||||
| Date of birth: 07.05.1973 | Place of birth: Russia | ||||||
| Permanent address: Kerch, Ukraine | |||||||
| Passport (OVIR): EA 290486 | Place of issue: Kerch | Date of issue: 05.10.2007 | Valid until: 05.10.2017 | ||||
| Seaman’s book: AB 325228 | Place of issue: Kerch | Date of issue: 16.11.2006 | Valid until: 16.11.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Katauskene Natalia | ||||||
| Supported children under age of 18 | 1. Darja Katauskaite, 10.08.2004 | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Marine School #12 | motorman | . | 01.07.1991 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00299/2005/03 | Illichivsk |
12.07.2005 |
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| Endorsement STCW | 00299/2005/03 | Illichivsk |
12.07.2005 |
01.07.2010 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 328 ILL | Illichivsk |
01.07.2005 |
01.07.2010 |
| Advanced Fire Fighting (A-VI/3) | 267 ILL | Illichivsk |
01.07.2005 |
01.07.2010 |
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Tanker Certificates |
. |
. |
. |
. |
| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 104 ILL | Illichivsk |
01.07.2005 |
01.07.2010 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) | 104 ILL | Illichivsk |
01.07.2005 |
01.07.2010 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 104 ILL | Illichivsk |
01.07.2005 |
01.07.2010 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Ost | Zevs Com |
1000 |
Ukraine |
Tug |
motorman |
01.02.2004 |
26.10.2004 |
| 2. Blue Star | Novstar Shipping |
7000 |
Kingstown |
Gen cargo |
motorman |
10.05.2006 |
27.10.2006 |
| 3. Athina | Salmar Shipping |
12388 |
Barbados |
Tanker |
motorman |
06.12.2006 |
26.07.2007 |
| 4. South Michelle | South Maritime |
4000 |
Willemstad |
Gen cargo |
motorman |
02.12.2007 |
27.06.2008 |
| 5. South Michelle | South Maritime |
4000 |
Willemstad |
Gen cargo |
motorman |
13.08.2008 |
04.12.2008 |
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Experience at sea: Since 1994 |
Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate KB 149418 | Issued: 06.08.2008 | Place: Kerch | Exp.date: 06.08.2009 | |
| Vaccination for cholera valid until: | Vaccination for yellow fever | |||
Ready to work from: any time