APPLICATION FORM
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APPLICATION FORM
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| Name: Alexander | Surname: Lyebyedyev | Father's name: |
| Date of birth: 29.03.1980 | Place of birth: Odessa, Ukraine | Personal Code: 2930810371 |
| Permanent addres: Odessa, Ukraine |
| Passport (OVIR): AX 108500 | Place of issue: Ukraine | Date of issue: 03.09.2002 | Valid until: 03.09.2012 |
| Seaman's book: AB 263004 | Place of issue: Ukraine | Date of issue: 04.06.2003 | Valid until: 04.06.2008 |
| Citizenship: Ukrainian | Expiry date of U.S. visa: NO |
| Marital Status | Married |
| Next of kin: (name, pas. No) | mother - Lyebyedyeva Galina - pass.# KK 797439 |
| Supported children under age of 18 | daughter - Lyebyedyeva Angelina - 17.01.2002 |
| (name, surname, date of birth) |
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| Knowledge of English language | Fair |
| Education: | Qualification: | No Diploma: | Date of Issue: |
| Odessa Marine College | Barman/waiter |
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
00417/2003/03 |
Odessa |
24.06.2003 |
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| Endorsement STCW |
00417/2003/03 |
Odessa |
24.06.2003 |
24.06.2008 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) |
LZ 49555B |
Odessa |
06.06.2003 |
06.06.2008 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2-1,2) |
LZ 49555B |
Odessa |
06.06.2003 |
06.06.2008 |
| Passenger Ships other then Ro-Ro (A-V/3) |
04081B |
Odessa |
11.06.2003 |
11.06.2008 |
Sea service (during five last years):
|
Name of vessel |
COMPANY |
Passanger Capacity |
Flag |
Tipe of vessel |
Position |
From |
To |
|
Taras Shevchenko |
Antarctika |
600 |
Ukraine |
pass |
barman |
23.09.2003 |
16.01.2004 |
| Experience at sea: Since 2003 | Knowledge Personal Computer (Yes/No): NO |
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: |
Ready to work from: ANY TIME