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APPLICATION FORM

 Name: Svitlana  Surname: Kopanyova
 Date of birth: 15.08.1967  Place of birth: Kazakhstan, USSR
 Permanent address: Odessa, Ukraine
 Passport (OVIR): EC 760425  Place of issue: Odessa  Date of issue: 09.10.2006  Valid until: 09.10.2016
 Seaman’s book: AB 341499  Place of issue: Odessa  Date of issue: 28.08.2006  Valid until: 28.08.2011
 Citizenship: Ukraine  Expiry date of U.S. visa: NO
 Marital Status  Divorced
 Next of kin: (name, pas. No)  son - Kopanyov Alexander - pass # KM 225969
 Supported children under age of 18  son - Kopanyov Alexander - 08.10.1986
 (name, surname, date of birth)  -
 Knowledge of English language  Satisfactory
 Education:  Qualification:  No Diploma:  Date of Issue:
 Odessa Marine Technical Scholl # 26   Ship's cook  427195  15.05.1986
 Odessa Marine Training Centre  Ship's cook  0103  25.05.2006 

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

00512/025768

Odessa

10.07.2006

--

 Endorsement STCW

00512/105409

Odessa

10.07.2006

10.07.2011

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

1072/2006

Odessa

06.06.2006

06.06.2011

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

00689

Kherson

02.03.2007

06.03.2012

 Refresher and updating courses

0103/2006

Odessa

25.05.2006

25.05.2011

Sea service (during five last years):

Name of vessel

COMPANY

crew/DWT

Flag

Type

Position

From

To

 Bar "Sasha"

Bar "Sasha"

70

Odessa, Ukraine

bar

cook

01.03.2001

01.03.2004

 Restaurant "Mario's"

Restaurant "Mario's"

100

Odessa, Ukraine

restaurant

cook

17.04.2004

10.02.2007

 Aras-8

Transoptimal

16

Sierra Leone

Gen. cargo

cook

06.03.2007

06.10.2007

 Celica

C.J. Helt & Co

1151

St.Vincent

Dry cargo

cook/OS

13.04.2008

01.09.2008

 Experience at sea: Since 2007  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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