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APPLICATION FORM |
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| Name: Olena | Surname: Burduzha | ||||||
| Date of birth: 15.05.1976 | Place of birth: Odessa | ||||||
| Permanent address: Odessa, Ukraine | |||||||
| Passport (OVIR): PO 328855 | Place of issue: Odessa | Date of issue: 19.03.2007 | Valid until: 19.03.2017 | ||||
| Seaman’s book: AB 332734 | Place of issue: Odessa | Date of issue: 05.05.2005 | Valid until: 05.05.2010 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 24.02.2013 | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Chesnyakova Raya | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| HVTS 26 | Stewardess | . | 1995 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00275/2004/08 |
Odessa |
22.04.2004 |
--- |
| Endorsement STCW |
00275/2004/08 |
Odessa |
22.04.2004 |
13.02.2014 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
200244B |
Odess |
13.02.2009 |
13.02.2014 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
10362B |
Odessa |
24.03.2008 |
24.03.2013 |
| Passenger ships other than Ro-Ro (A-V/3) |
03114B |
Odessa |
23.02.2009 |
23.02.2014 |
Sea service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Hebridean Spirit | Univis |
70 |
UK |
Yacht |
Stewardess |
07.09.2006 |
13.12.2006 |
| Hebridean Spirit | Univis |
70 |
UK |
Yacht |
Stewardess |
12.04.2007 |
17.08.2007 |
| Yacht Express | Univis |
. |
N.Antilles |
Heavy lift |
Stewardess |
23.03.2008 |
18.09.2008 |
| Experience at sea: Since 1995 | Knowledge Personal Computer (Yes / No): No | |||
| Medical Certificate | ¹ | Issued: | Place: | Exp.date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 27.03.2018 | |||
Ready to work from: any time