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APPLICATION FORM |
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| Name: Tetyana | Surname: Markova | ||||||
| Date of birth: 24.08.1983 | Place of birth: Ilyichevsk, Ukraine | ||||||
| Permanent address: Ilyichevsk, Ukraine | |||||||
| Passport (OVIR): AX 961601 | Place of issue: Ilyichevsk | Date of issue: 13.10.2003 | Valid until: 13.10.2013 | ||||
| Seaman’s book: AB 286031 | Place of issue: Ilyichevsk | Date of issue: 26.11.2003 | Valid until: 20.03.2013 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | Mother - Markova Nadejhda | ||||||
| Supported children under age of 18 | -- | ||||||
| (name, surname, date of birth) | -- | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Odessa Marine Training Ñourses | Waitress-Barman | # 162/211103 | 21.11.2003 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency |
162/211103 |
Odessa |
21.11.2003 |
21.11.2008 |
| Personal Sea Survival techniques, fire prevention and fire fighting (A-VI/1) |
LZ#55886B |
Odessa |
14.11.2003 |
14.11.2008 |
| Ro-Ro Passenger ships (A-V/2) |
LZ#04482B |
Odessa |
06.05.2004 |
06.05.2009 |
| Passenger ships other than Ro-Ro (A-V/3) |
LZ#07470B |
Odessa |
04.04.2005 |
04.04.2010 |
Sea service (during five last years):
|
Name of vessel |
Company |
Passenger Cap. |
Flag |
Type |
Position |
From |
To |
| Jasmine |
Mano Ltd |
700 pass. |
Kingstown |
pass |
waitress |
08.05.2004 |
08.09.2004 |
| Jasmine |
Mano Ltd |
700 pass. |
Kingstown |
pass |
waitress |
07.06.2005 |
18.10.2005 |
| Emirald |
Volans |
1100 pass. |
Greece |
pass |
bar-waitress |
28.08.2006 |
26.03.2007 |
| Emirald |
Volans |
1100 pass. |
Greece |
pass |
bar-waitress |
18.06.2007 |
01.11.2007 |
| Emirald |
Volans |
1100 pass. |
Greece |
pass |
bar-waitress |
16.04.2008 |
03.11.2008 |
| Experience at sea: since 2004 | Knowledge Personal Computer (Yes / No): | |||
| Medical Certificate | ¹ 000626 | Issued: 02.12.2004 | Place: Odessa | Exp.date: 02.12.2005 |
| Vaccination for cholera valid until: | Vaccination yellow fever valid until: | |||
Ready to work from: any time