APPLICATION FORM
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APPLICATION FORM |
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| Name: | Natalia | ||||
| Surname: | Mandrik | ||||
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Date of Birth: |
30.04.1975 | ||||
| Place of Birth: | Odessa | ||||
| Permanent address: | Odessa, Ukraine | ||||
| Citizenship: | Ukraine | ||||
| Passport No.: | AH 576461 | ||||
| Date of issue: | 15.05.1998 | ||||
| Place of issue: | Odessa, Ukraine | ||||
| Valid untill: | 15.05.2008 | ||||
| Seaman's Book No.: | AB 074866 | ||||
| Date of issue: | 23.04.2001 | ||||
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Place of issue: |
port Ilyichevsk, Odessa reg. | ||||
| Valid untill: | 23.04.2006 | ||||
| Expiry date of U.S. visa: | NO | ||||
| vaccination valid untill for cholera: | . | ||||
| vaccination valid untill for yellow fever: | 02.04.2011 | ||||
| Date of last medical certificate: | 02.06.2003 | ||||
| Marital status: | Married: | Single: X | Divorced: | Widower: | |
| Next of kin: (name, pas. No) | Mother - Radzivilova Zoya | ||||
| Supported children under age of 18 | - | ||||
| (name, surname, date of birth) | - | ||||
| Knowledge of English language: | Very good: | Good: | Satisfactory: | Fair: X | Poor: |
Licences, grades, certificates:
|
Licence held/grade, certificate |
No. |
Authority |
Country |
Date of issue |
Expiry date |
| Certificate Stewardess |
14369471 |
"TRAINING AND CERTIFYING |
Ukraine |
20.03.2001 |
20.03.2006 |
| Endorsement |
2479/2001 |
CENTRE SURVIVAL |
Ukraine |
26.03.2001 |
26.03.2006 |
| Certificate A-VI / I "LZ" |
23223 B |
AT SEA OF ODESSA" |
Ukraine |
24.04.2001 |
24.04.2006 |
| Certificate V-2 "LZ" |
00392 B |
CENTRE SURVIVAL |
Ukraine |
16.07.2001 |
16.07.2006 |
| Certificate V-3 "LZ" |
00907 B |
AT SEA OF ODESSA" |
Ukraine |
15.11.2001 |
24.04.2006 |
Sea service (during five last years):
|
Name of vessel |
Company |
HP/DWT |
Flag |
Type |
Position |
From |
To |
| T. Shevchenko | UMA |
. |
Ukraine |
pass |
Stewardess |
14.08.2001 |
02.11.2003 |
Ready to work from: ANY TIME