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APPLICATION FORM |
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| Name: Denis | Surname: Ponomarenko | ||||||
| Date of birth: 29.08.1987 | Place of birth: Nikolaev | ||||||
| Permanent address: Nikolaev, Ukraine | |||||||
| Passport (OVIR): EA 469583 | Place of issue: Nikolaev | Date of issue: 03.12.2007 | Valid until: 03.07.2017 | ||||
| Seaman’s book: AB 357620 | Place of issue: Nikolaev | Date of issue: 25.01.2008 | Valid until: 26.12.2012 | ||||
| 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 | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| College #11 | Welder | . | 2005 | ||||
| Marine School | motorman | . | 2008 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00375/2008/07 | Nikolaev |
27.08.2008 |
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| Endorsement STCW | 00375/2008/07 | Nikolaev |
27.08.2008 |
28.11.2012 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) | 05078/2007/42/01 | Nikolaev |
28.11.2007 |
28.11.2012 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 06187/2008/42/02 | Nikolaev |
17.09.2008 |
17.09.2013 |
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Tanker Certificates |
. |
. |
. |
. |
| Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 01630/2009/42/10 | Nikolaev |
11.02.2009 |
11.02.2014 |
| LPG carrier (Advanced and Familiarization, A-V/1, p.2-7) | 01630/2009/42/10 | Nikolaev |
11.02.2009 |
11.02.2014 |
| Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7) | 01630/2009/42/10 | Nikolaev |
11.02.2009 |
11.02.2014 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Volgo-Balt 121 | Tedial-Shipping | . | Ukraine | Dry cargo |
apprentice |
04.02.2008 |
29.05.2008 |
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Experience at sea: Since 2008 |
Knowledge Personal Computer (Yes / No): | |||
| Medical Certificate # 0677 | Issued: 25.07.2008 | Place: Nikolaev | Exp.date: 25.07.2009 | |
| Vaccination for cholera valid until: | Vaccination for yellow fever | |||
Ready to work from: any time