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APPLICATION FORM |
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| 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 | . | . | ||||
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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):
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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