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APPLICATION FORM

 Name: Volodymyr  Surname: Gorodnycenko
 Date of birth: 22.04.1975  Place of birth: Odessa
 Permanent address: Odessa, Ukraine
 Passport (OVIR): AK 908216  Place of issue: Odessa  Date of issue: 25.04.2006  Valid until: 25.04.2016
 Seaman’s book: AB 259025  Place of issue: Odessa  Date of issue: 05.11.2002  Valid until: 10.09.2010
 Citizenship: Ukraine  Expiry date of U.S. visa: NO
 Marital Status  Married
 Next of kin: (name, pas. No)  wife - Gorodnychenko Irina
 Supported children under age of 18  1. Anna Gorodnychenko, 27.11.1999
 (name, surname, date of birth)  .
 Knowledge of English language  Good
 Education:  Qualification:  No Diploma:  Date of Issue:
 Odessa High Vocational School #26   Cook  .  05.06.1995

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

01077/2003/01

Izmail

03.10.2003

---

 Endorsement STCW

01077/2003/01

Illichivsk

04.09.2008

04.09.2013

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

107973B

Odessa

14.07.2008

14.07.2013

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

61448B

Odessa

17.01.2006

17.01.2011

Sea service (during five last years):

Name of vessel

COMPANY

DWT

Flag

Type

Position

From

To

 Spirit  V.Ships

.

Nasau

Bulker

Messman

15.07.2004

12.01.2005

 Rosa M   Dopson

.

Malta

Container

Cook

09.06.2006

08.11.2006

 Experience at sea: Since 2000  Knowledge Personal Computer (Yes / No): 
 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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