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APPLICATION FORM |
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| Name: Vasil | Surname: Kulatov | ||||||
| Date of birth: 01.01.1962 | Place of birth: Odessa. Ukraine | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): AT 675145 | Place of issue: Odessa | Date of issue: 01.02.2001 | Valid until: 01.02.2011 | ||||
| Seaman’s book: AB 072819 | Place of issue: Illichevsk | Date of issue: 27.12.2000 | Valid until: 27.12.2005 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Mother - Kulatova Vera | ||||||
| Supported children under age of 18 | -- | ||||||
| (name, surname, date of birth) | -- | ||||||
| Knowledge of English language | Poor | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa Marine School | Motorman | 417 | 06.1984 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
039 IL |
Illichevsk |
19.09.2003 |
19.09.2008 |
| Endorsement STCW |
- |
- |
- |
- |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
LZ 03709B |
Odessa |
20.06.2003 |
20.06.2008 |
| Advanced Fire Fighting (A-VI/3) |
LZ 50205B |
Odessa |
20.06.2003 |
20.06.2008 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
LZ 36993B |
Odessa |
20.06.2003 |
20.06.2008 |
| Crowd Management (A-VI/4-1) |
LZ 04166B |
Odessa |
20.06.2003 |
20.06.2008 |
Sea service (during five last years):
|
Name of vessel |
COMPANY |
HP/DWT |
Flag |
Type |
Position |
From |
To |
|
1. Taras Shevchenko |
Antarctica |
21000/21000 |
Ukraine |
passenger |
motorman |
1984 |
2004 |
| Experience at sea: since 1984 | Knowledge Personal Computer (Yes / No): No | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: |
. | |||
Ready to work from: ANY TIME