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APPLICATION FORM

 Name: Sergiy  Surname: Belenko
 Date of birth: 28.02.1965  Place of birth: Ukraine
 Permanent address: Zaporizza reg, Ukraine
 Passport (OVIR): AC 200072  Place of issue: Berdyansk  Date of issue: 02.03.1996  Valid until: 02.03.2016
 Seaman’s book: AB 282079  Place of issue: Mariupol  Date of issue: 05.08.2005  Valid until: 05.08.2010
 Citizenship: Ukraine  Expiry date of U.S. visa: 31.07.2011
 Marital Status  Married
 Next of kin: (name, pas. No)  wife - Belenko Ekaterina
 Supported children under age of 18  1. Elizaveta Belenko, 26.07.1993
 (name, surname, date of birth)  .
 Knowledge of English language  Satisfactory
 Education:  Qualification:  No Diploma:  Date of Issue:
 Medical College   First Aid Officer  .  01.03.1984
 Culinary College   Cook  .  16.06.1996
 Azov Regional Intsitute of Management   Manager in restaurant serves  .  21.02.2002

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

00085/2003/06

Mariupol

11.03.2003

---

 Endorsement STCW

00085/2003/06

Mariupol

25.12.2007

21.06.2010

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

0081690-AS

Mariupol

21.06.2005

21.06.2010

 Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2)

06010-AS

Mariupol

19.07.2006

19.07.2011

 Liberia Seaman's book 

0751293

Liberia

11.08.2006

11.08.2011

 Antigua & Barbuda Seaman's book 

78880

Antigua

21.04.2008

20.04.2013

 Tanker Certificates

.

.

.

.

 Chemical Tanker (Advanced and Familiarization, A-V/1, p.2-7)

1774-AS

Mariupol

07.07.2006

07.07.2011

 LPG carrier (Advanced and Familiarization, A-V/1, p.2-7)

1774-AS

Mariupol

07.07.2006

07.07.2011

 Oil Tanker (Advanced and Familiarization, A-V/1, p.2-7)

1774-AS

Mariupol

07.07.2006

07.07.2011

Sea service (during five last years):

Name of vessel

Company

DWT

Flag

Type

Position

From

To

 Amaltia  Target Marine 

9678

Panama

Reefer

Cook

05.08.2004

12.03.2005

 Kerkis  Samos Steamship 

280000

Bagame

Bulker

Steward

12.09.2005

12.03.2006

 Cape Banks   Marlow Navigation 

30000

Liberia

Ch. tanker

Steward

13.08.2006

04.02.2007

 Cape Bear   Marlow Navigation 

30000

Liberia

Ch. tanker

Steward

01.06.2007

16.11.2007

 Cape Banks   Marlow Navigation 

30000

Liberia

Ch. tanker

Steward

17.01.2008

30.03.2008

 Blue Giant  Marlow Navigation

31000

Antigua

Combi Dock

Steward

11.08.2008

15.09.2008

 Experience at sea: Since 1999  Knowledge Personal Computer (Yes / No): Yes 
 Medical Certificate  ¹ 2609  Issued: 08.08.2008  Place: Mariupol  Exp.date: 08.08.2009
 Vaccination for cholera valid until:  Vaccination for yellow fever valid until: 07.07.2010 

Ready to work from:  any time

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