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APPLICATION FORM |
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| Name: Liliya | Surname: Glavanchuk | ||||||
| Date of birth: 26.12.1975 | Place of birth: Donetsk | ||||||
| Permanent address: Ugledar, Ukraine | |||||||
| Passport (OVIR): KC 643155 | Place of issue: Donetsk | Date of issue: | Valid until: 14.07.2009 | ||||
| Seaman’s book: AB 147429 | Place of issue: Odessa | Date of issue: | Valid until: 14.07.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: 14.05.2008 | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Vera Glavanchuk - mother | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Very Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Institute of linguistics. Gorlovka | Specialist. Teacher | - | 17.07.1998 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
2371/2006 |
Odessa |
26.10.2006 |
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| Endorsement STCW |
--- |
--- |
--- |
--- |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
LZ14278B |
Odessa |
11.10.2006 |
11.10.2011 |
| Proficiency in Survival craft, Rescue Boats & Fast Rescue Boats (A-VI/2) |
LZ06864B |
Odessa |
11.10.2006 |
11.10.2011 |
| Ro-Ro Passenger ships (A-V/2) |
LZ00081B |
Odessa |
11.10.2006 |
11.10.2011 |
| Passenger ships other than Ro-Ro (A-V/3) |
LZ01234B |
Odessa |
11.10.2006 |
11.10.2011 |
Sea service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| 1. Astor | QSC |
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Panama |
Pass |
Bar waiter |
10.2006 |
03.2007 |
| 2. Conquest | Carnival |
--- |
Panama |
Pass |
hskp. |
10.2005 |
06.2006 |
| 3. Conquest | Carnival |
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Panama |
Pass |
hskp. |
01.2005 |
09.2005 |
| 4. Exctasy | Carnival |
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Panama |
Pass |
hskp. |
03.2004 |
11.2004 |
| 5. Regal Empress | Imp. Majesty |
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Bahamas |
Pass |
Hostess |
06.2003 |
01.2004 |
| 6. Topas | TMP |
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Bahamas |
Pass |
Reception |
03.2002 |
08.2002 |
| Experience at sea: Since 2002 | Knowledge Personal Computer (Yes / No): | |||
| Medical Certificate | ¹ | Issued: | Place: Odessa | Exp.date: 2008 |
| Vaccination for cholera valid until: 11.2011 | Vaccination for yellow fever valid until: 11.2011 | |||
Ready to work from: any time