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APPLICATION FORM

 Name: Maksym  Surname: Legostayev
 Date of birth: 26.05.1985  Place of birth: Makeevka, Donetsk reg.
 Permanent address: Makeevka, Donetsk reg., Ukraine
 Passport (OVIR): AX 694154  Place of issue: Donetsk  Date of issue: 27.08.2003  Valid until: 27.08.2013
 Seaman’s book: AB 338239  Place of issue: Odessa  Date of issue: 10.03.2006  Valid until: 10.03.2011
 Citizenship: Ukraine  Expiry date of U.S. visa: NO
 Marital Status  Single
 Next of kin: (name, pas. No)  Lyubov
 Supported children under age of 18  .
 (name, surname, date of birth)  .
 Knowledge of English language  Good
 Education:  Qualification:  No Diploma:  Date of Issue:
 Odessa UDP #26   Steward  .  2006

Certificates of STCW 78/95

No.

Place

Date of issue

Expiry date

 Certificate of competency

00156/2006/08

Odessa

14.03.2006

---

 Certificate Addition 

0070/2006

Odessa

27.01.2006

---

 Endorsement STCW

00156/2006/08

Odessa

14.03.2006

14.02.2011

 Basic Safety Training and Instruction (A-VI/1)

LZ 87755B

Odessa

20.01.2006

20.01.2011

 Ro-Ro Passenger ships (A-V/2)

LZ 06777B

Odessa

27.02.2006

27.02.2011

 Passenger ships other than Ro-Ro (A-V/3)

LZ 00100B

Odessa

27.02.2006

27.02.2011

Sea service (during five last years):

Name of vessel

Company

Pass capacity

Flag

Type

Position

From

To

 Greifswald  Ukrferry

150

Georgia

Ro-Ro

Steward

28.03.2006

---

 Yuzhnaya Palmira   Ukrferry

500

Turkey

Ro-Ro

Waiter

---

03.08.2007

 Delphin  Delphin Shipping 

.

.

.

Utility Dishw.

03.08.2007

29.12.2007

 Yuzhnaya Palmira   Ukrferry

500

Turkey

Ro-Ro

Waiter

29.12.2007

05.01.2009

 Greifswald  Ukrferry

150

Georgia

Ro-Ro

Waiter

05.01.2009

03.04.2009

 Greifswald  Ukrferry

150

Georgia

Ro-Ro

Waiter

03.04.2009

02.06.2009

 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 yellow fever valid until: 27.07.2017 

Ready to work from:  any time

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