|
|
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