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APPLICATION FORM

 Name: Yuriy  Surname: Lapunko
 Date of birth: 23.05.1978  Place of birth: Kaliningrad
 Permanent address: Sevastopol, Ukraine
 Passport (OVIR): AN 682860  Place of issue: Sevastopol  Date of issue: 28.04.2001  Valid until: 26.04.2011
 Seaman’s book: AB 008101  Place of issue: Sevastopol  Date of issue: 30.03.2000  Valid until: 30.03.2010
 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  Satisfactory
 Education:  Qualification:  No Diploma:  Date of Issue:
 Sevastopol Navy Marine Institute   .  .  1998

 Certificates of STCW 78/95

 No.

 Place

 Date of issue

 Expiry date

 Certificate of competency (welder)  00082/2005/09  Sevastopol

04.08.2005

---

 Endorsement STCW (welder)  00082/2005/09  Sevastopol

08.06.2007

10.09.2009

 Certificate of competency (AB)  00466/2006/10

 Sevastopol

13.06.2006

---

 Endorsement STCW (AB)  00466/2006/10  Sevastopol

11.06.2007

12.07.2010

 Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1)  0365/2005  Sevastopol

12.07.2005

12.07.2010

 Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2)  00508C  Sevastopol

12.05.2006

13.05.2011

 Tanker Certificates

.

.

.

.

 Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7)  02910C  Sevastopol

25.05.2007

25.05.2012

Sea service (during five last years):

Name of vessel

Company

DWT

Flag

Type

Position

From

To

 Muzestveny  .

.

Ukraine

Ocean tug

AB

2001

2004

 Ecotech  .

.

Ukraine

Cable vessel

welder

2005

2007

 Experience at sea: Since 2001

 Knowledge Personal Computer (Yes / No): no
 Medical Certificate  Issued:  Place:  Exp.date: 01.11.2008
 Vaccination for cholera valid until:  Vaccination for yellow fever valid until: 19.01.2009

Ready to work from:  23.11.2007

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