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APPLICATION FORM

 Name: Oksana  Surname: Gorobets
 Date of birth: 01.01.1984  Place of birth: Petropavlovsk-Kamchatsk
 Permanent address: Chmelnitsk, Ukraine
 Passport (OVIR): EA 862288   Place of issue: Odessa  Date of issue: 04.04.2008  Valid until: 04.04.2018
 Seaman’s book: AB 379121  Place of issue: Izmail  Date of issue: 17.01.2008  Valid until: 17.01.2013
 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:
 Izmail Vocational School   .  .  01.02.2005

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

00051/2008/01

Izmail

26.03.2008

---

 Endorsement STCW

00051/2008/01

Izmail

26.03.2008

04.03.2013

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

101619 U

Izmail

04.03.2008

04.03.2013

 Ro-Ro Passenger ships (A-V/2)

6080

Izmail

02.02.2005

02.02.2010

 Passenger ships other than Ro-Ro (A-V/3)

7072

Izmail

02.02.2005

02.02.2010

Sea service (during five last years):

Name of vessel

COMPANY

DWT

Flag

Type

Position

From

To

 Princessa Dnipra   Chervona Ruta 

.

Ukraine

Pass

Cook

19.04.2004

15.10.2004

 Dnipro  UDP Izmail 

.

Ukraine

Pass

Cook

28.03.2005

04.08.2005

 Dnipro  UDP Izmail 

.

Ukraine

Pass

Pastry-cook

04.08.2005

28.10.2005

 Volga  UDP Izmail 

.

Ukraine

Pass

Pastry-cook

22.03.2006

01.07.2006

 Dnipro  UDP Izmail 

.

Ukraine

Pass

Cook

01.07.2006

24.10.2006

 Volga  UDP Izmail

.

Ukraine

Pass

Cook

28.04.2007

04.11.2007

 Experience at sea: Since 2004  Knowledge Personal Computer (Yes / No): Yes 
 Medical Certificate  ¹  Issued:  Place:  Exp.date:
 Vaccination for cholera valid until:  Vaccination for yellow fever valid until:

Ready to work from:  any time

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