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APPLICATION FORM

 Name: Vladymyr  Surname: Storozhyk
 Date of birth: 04.08.1983  Place of birth: Odessa
 Permanent address: Odessa, Ukraine
 Passport (OVIR): AX 103943  Place of issue: Odessa  Date of issue: 08.07.2002  Valid until: 08.07.2012
 Seaman’s book: AB 081958  Place of issue: Odessa  Date of issue: 08.07.2007  Valid until: 08.07.2012
 Citizenship: Ukraine  Expiry date of U.S. visa: NO
 Marital Status  Single
 Next of kin: (name, pas. No)  Storozhuk Nadezhda
 Supported children under age of 18  .
 (name, surname, date of birth)  .
 Knowledge of English language  Good
 Education:  Qualification:  No Diploma:  Date of Issue:
 Vocational School   cook  .  .

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

00916/2003/03

Odessa

15.07.2008

---

 Endorsement STCW

00916/2003/03

Odessa

15.07.2008

15.07.2013

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

107994B

Odessa

15.07.2008

15.07.2013

 Ro-Ro Passenger ships (A-V/2)

01127B

Odessa

15.07.2008

15.07.2013

 Passenger ships other than Ro-Ro (A-V/3)

01931B

Odessa

15.07.2008

15.07.2013

Sea service (during five last years):

Name of vessel

COMPANY

DWT

Flag

Type

Position

From

To

 Sky wonder   Pullmantur

.

Panama

Pass

3-rd cook

15.08.2006

18.04.2007

 Delphin Voyager   MTS

.

Panama

Pass

As. cook

29.08.2007

20.11.2007

 Delphin   MTS

.

Panama

Pass

2-nd cook

14.12.2007

20.05.2008

 Fashion Diamond   Global

.

Panama

Ro-Ro/Pass

Ch. cook

12.09.2008

15.01.2009

 Experience at sea: Since 2006  Knowledge Personal Computer (Yes / No): Yes
 Medical Certificate  ¹  Issued:  Place:  Exp.date:
 Vaccination for cholera valid until:  Vaccination for cholera valid until: 10.10.2015 

Ready to work from:  any time

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