|
|
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