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APPLICATION FORM |
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| Name: Igor | Surname: Akymov | ||||||
| Date of birth: 01.12.1981 | Place of birth: Moldova | ||||||
| Permanent address: Krasnoye, Slobodzeysky reg, Moldova | |||||||
| Passport (OVIR): KC 075651 | Place of issue: Moldova | Date of issue: 23.10.2002 | Valid until: 23.10.2012 | ||||
| Seaman’s book: AB 341568 | Place of issue: Moldova | Date of issue: 01.09.2006 | Valid until: 01.09.2011 | ||||
| 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: | ||||
| Odessa Maritime Training Centre | Ship's Cook | . | 2006 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00426/2006/08 |
Odessa |
30.05.2006 |
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| Endorsement STCW |
00426/2006/08 |
Odessa |
30.05.2006 |
18.04.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
0685/2006 |
Odessa |
18.04.2006 |
18.04.2011 |
Sea service (during five last years):
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Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| Experience at sea: - | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: 14.12.2007 | Place: Odessa | Exp.date: 14.12.2008 |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: | |||
Ready to work from: any time