APPLICATION FORM

 Name: Mykhaylo  Surname: Ul'yanov
 Date of birth: 10.02.1988  Place of birth: Kherson
 Permanent address: Kherson, Ukraine
 Passport (OVIR): EE 058164  Place of issue: Kherson  Date of issue: 23.05.2008  Valid until: 23.05.2018
 Seaman’s book: AB 362889  Place of issue: Kherson  Date of issue: 23.10.2007  Valid until: 23.10.2012
 Citizenship: Ukraine  Expiry date of U.S. visa: NO
 Marital Status  Single
 Next of kin: (name, pas. No)  Ul'yanov Il'ya
 Supported children under age of 18  
 (name, surname, date of birth)  
 Knowledge of English language  Satisfactory
 Education:  Qualification:  Date of Issue:
 Kherson Maritime Training Centre   Electrician  13.02.2008

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

00011/2008/11

Kherson

13.02.2008

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 Endorsement STCW

00011/2008/11

Kherson

13.02.2008

21.09.2012

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

11725/07 KH

Kherson

21.09.2007

21.09.2012

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

8023/07 KH

Kherson

21.09.2007

21.09.2012

 Tanker Certificates

 

 

 

 

 Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7)

0776/07 KH

Kherson

14.12.2007

14.12.2012

 LPG carrier (Advanced and Familiarization, A-V/1, p.2-7)

0776/07 KH

Kherson

14.12.2007

14.12.2012

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

0776/07 KH

Kherson

14.12.2007

14.12.2012

Sea service (during five last years):

Name of vessel

COMPANY

DWT

Flag

Type

Position

From

To

 Baltic Strait 

 Aquaship Ltd

12545

Panama

Reefer

Electrician

02.10.2008

02.05.2009

 Experience at sea: Since 2008  Knowledge Personal Computer (Yes / No): Yes 
 Medical Certificate  ¹  Issued:  Place:  Exp.date:
 Vaccination for cholera valid until:  Vaccination for yellow fever valid until: 27.11.2017