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APPLICATION FORM |
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| 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 | ||||
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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