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APPLICATION FORM |
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| Name: Lyudmyla | Surname: Sopina | ||||||
| Date of birth: 07.01.1966 | Place of birth: Ukraine | ||||||
| Permanent address: Nikolaev, Ukraine | |||||||
| Passport (OVIR): EE 139497 | Place of issue: Nikolaev | Date of issue: 09.06.2008 | Valid until: 09.06.2018 | ||||
| Seaman’s book: AB 357017 | Place of issue: Nikolaev | Date of issue: 10.08.2007 | Valid until: 09.08.2012 | ||||
| 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 | Fair | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Marine Vocational School | cook | 27.07.2007 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00205/2007/07 |
Nikolaev |
27.07.2007 |
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| Endorsement STCW |
00205/2007/07 |
Nikolaev |
27.07.2007 |
11.07.2012 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
03934 |
Nikolaev |
11.07.2007 |
11.07.2012 |
Sea service (during five last years):
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Name of vessel |
COMPANY |
DWT |
Flag |
Type |
Position |
From |
To |
| Sun Bee | Sun Glory Shipping |
1500 |
Panama |
Fishboat |
cook |
10.02.2007 |
28.06.2007 |
| Sun Bee | Oriental Shipping Co Ltd |
1500 |
Sierra Leone |
Fishboat |
cook |
08.09.2007 |
28.04.2008 |
| 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