APPLICATION FORM
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APPLICATION FORM |
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| Name: Dmitro | Surname: Cherviovsky | ||||||
| Date of birth: 30.09.1975 | Place of birth: Kiev | ||||||
| Permanent address: Simferopol, Ukraine | |||||||
| Phone: +38-0692-923677; mob.+38-050-5325845 | |||||||
| Passport (OVIR): AT 026704 | Place of issue: Simferopol | Date of issue: 08.08.2002 | Valid until: 08.08.2012 | ||||
| Seaman’s book: AB 320665 | Place of issue: Simferopol | Date of issue: 22.09.2006 | Valid until: 15.09.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 16.07.2012 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Cherviovskaya Angela, AP 388433 | ||||||
| Supported children under age of 18 | 1. Sherviovsky Nikita, 19.07.2006 | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Simferopol College | Cook | . | 26.06.1998 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00117/2002/10 |
Sevastopol |
23.10.2002 |
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| Endorsement STCW |
00117/2002/10 |
Sevastopol |
11.10.2006 |
22.09.2011 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
10643 C |
Sevastopol |
22.09.2006 |
23.09.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
0244/2008 |
Odessa |
20.02.2008 |
20.02.2013 |
| Antigua & Barbuda Seaman's book |
63040 |
Ant&Barb |
07.12.2006 |
06.12.2011 |
Sea service (during five last years):
|
Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| Pacific Spirit | Lagoa Shipping Co |
11000 |
Malta |
Reefer |
messboy |
09.06.2003 |
16.02.2004 |
| Pacific Spirit | Lomar |
11000 |
Malta |
Reefer |
Cook |
12.06.2004 |
15.12.2004 |
| Polar Costa Rica | Lomar |
8200 |
Malta |
Reefer |
Cook |
04.03.2005 |
22.09.2005 |
| Amistad | Lomar |
5700 |
Bahamas |
Reefer |
Cook |
27.11.2005 |
22.07.2006 |
| Med Prodigy | BBC Shipping Ltd |
3200 |
Barbuda |
Multipurp |
Cook |
11.11.2006 |
15.15.2007 |
| BBC Elbe | BBC Shipping Ltd |
17000 |
Barbuda |
Multipurp |
Cook |
24.07.2007 |
05.02.2008 |
| Experience at sea: Since 2002 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ 3387 | Issued: 19.03.2008 | Place: Sevastopol | Exp.date: 19.03.2009 |
| Vaccination for cholera valid until: 01.12.2011 | Vaccination for yellow fever valid until: 15.04.2013 | |||
Ready to work from: any time