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APPLICATION FORM |
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| 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 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 0008/2009/08 | Odessa |
15.01.2009 |
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| 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):
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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 |
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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