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APPLICATION FORM |
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| Name: Vitaliy | Surname: Manko | ||||||
| Date of birth: 19.08.1974 | Place of birth: Kiliya | ||||||
| Permanent address: Kiliya, Odessa reg., Ukraine | |||||||
| Passport (OVIR): EA 916024 | Place of issue: Odessa | Date of issue: 21.04.2008 | Valid until: 21.04.2018 | ||||
| Seaman’s book: AB 380236 | Place of issue: Izmail | Date of issue: 03.06.2008 | Valid until: 03.06.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Manko Irina | ||||||
| Supported children under age of 18 | 1. Nikita Manko, 06.10.1999 | ||||||
| (name, surname, date of birth) | 2. Ksenia Manko, 04.03.2005 | ||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa Marine College | Ship's welder | . | 24.11.2008 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00524/2008/08 | Odessa |
17.12.2008 |
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| Endorsement STCW | 00524/2008/08 | Odessa |
17.12.2008 |
22.04.2013 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 103083U | Izmail |
22.04.2008 |
22.04.2013 |
| Advanced Fire Fighting (A-VI/3) | 14189U | Izmail |
12.09.2008 |
12.09.2013 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 17147U | Izmail |
16.09.2008 |
16.09.2013 |
| Bureau Veritas Welder Qualification Certificate | ODS/005/NC/08 | Kiliya |
15.02.2008 |
14.02.2010 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| . | Vyborg Shipyard | . | Russia | . |
fitter |
10.10.2004 |
12.03.2005 |
| . | St.Petersburg Shipyard | . | Russia | . |
fitter |
01.06.2005 |
29.09.2005 |
| . | Vyborg Shipyard | . | Russia | . |
fitter |
02.01.2006 |
07.07.2006 |
| . | Vyborg Shipyard | . | Russia | . |
fitter |
03.10.2006 |
05.02.2007 |
| . | St.Petersburg Shipyard | . | Russia | . |
fitter |
12.06.2007 |
14.09.2007 |
| . | St.Petersburg Shipyard | . | Russia | . |
fitter |
18.12.2007 |
21.04.2008 |
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Experience at sea: Shipyard Experience |
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