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APPLICATION FORM

 Name: Pavlo  Surname: Kharlambov
 Date of birth: 18.11.1976  Place of birth: Odessa reg.
 Permanent address: Odessa, Ukraine
 Passport (OVIR): AE 660787  Place of issue: Odessa  Date of issue: 26.11.1997  Valid until: 01.01.2012
 Seaman’s book: AB 010730  Place of issue: Odessa  Date of issue: 09.04.2001  Valid until: 09.04.2011
 Citizenship: Ukraine  Expiry date of U.S. visa: NO
 Marital Status  Married
 Next of kin: (name, pas. No)  wife - Mikhailova Olga
 Supported children under age of 18  1. Kharlambova Oleksandra, 22.10.2005
 (name, surname, date of birth)  .
 Knowledge of English language  Satisfactory
 Education:  Qualification:  No Diploma:  Date of Issue:
 Kiev State Marine Academy of Water Transport   Engineer  .  2000

 Certificates of STCW 78/95

 No.

 Place

 Date of issue

 Expiry date

 Certificate of competency  0008/2009/08  Odessa

15.01.2009

---

 Endorsement STCW  0008/2009/08  Odessa

15.01.2009

04.11.2013

 Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1)  4462/2008  Odessa

04.11.2008

04.11.2013

 Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2)  3291/2008  Odessa

03.11.2008

03.11.2013

Sea service (during five last years):

Name of vessel

Company

DWT

Flag

Type

Position

From

To

 DE-21  Ust-Dunai vodoput'  464  Ukraine  Dredger

motorman

18.11.1999

07.12.2000

 Tashkent  Port of Izmail  475  Ukraine  Tug

motorman

20.01.2001

04.02.2004

 Experience at sea: Since 1999

 Knowledge Personal Computer (Yes / No): Yes 
 Medical Certificate  Issued:  Place:  Exp.date:
 Vaccination for cholera valid until:  Vaccination for yellow fever

Ready to work from:  any time

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