|
|
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