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APPLICATION FORM |
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| Name: Sergey | Surname: Maksimenko | ||||||
| Date of birth: 25.04.1977 | Place of birth: Ukraine | ||||||
| Permanent address: Vinnitsa, Ukraine | |||||||
| Passport (OVIR): AH 26138 | Place of issue: Vinnitsa | Date of issue: 27.12.1999 | Valid until: 27.12.2009 | ||||
| Seaman’s book: AB 342503 | Place of issue: Odessa | Date of issue: 13.10.2006 | Valid until: 13.10.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 23.10.2011 | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Makismenko Elena | ||||||
| Supported children under age of 18 | 1. Maksimenko Yana | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Vinnitsa Vocational School | cook | . | 01.09.1995 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00500 |
Odessa |
01.07.2003 |
--- |
| Endorsement STCW |
00500 |
Odessa |
25.06.2008 |
25.06.2013 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
104541B |
Odessa |
17.04.2008 |
17.07.2013 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
06184B |
Odessa |
12.09.2006 |
12.07.2011 |
Sea service (during five last years):
|
Name of vessel |
COMPANY |
Pass capacity |
Flag |
Type |
Position |
From |
To |
| Rio Negro | NMS |
2300 |
Liberia |
Container |
Ch. cook |
06.06.2004 |
21.01.2005 |
| Henrich Oldendorff | NMS |
70000 |
Liberia |
Pana-max |
Ch. cook |
09.05.2005 |
15.11.2005 |
| Beluga Resolution | Beluga |
10000 |
Germany |
Heavy lift |
Ch. cook |
23.02.2006 |
31.07.2006 |
| Beluga Recomend | Beluga |
10000 |
Germany |
Heavy lift |
Ch. cook |
22.11.2006 |
02.06.2007 |
| Beluga Constetut | Beluga |
10000 |
Antigua |
Heavy lift |
Ch. cook |
23.10.2007 |
26.03.2008 |
| Kamina | Delmas |
. |
. |
Container |
Ch. cook |
16.07.2008 |
01.01.2009 |
| Experience at sea: Since 2002 | Knowledge Personal Computer (Yes / No): Yes | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for cholera valid until: 23.02.2010 | |||
Ready to work from: any time