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APPLICATION FORM |
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| Name: Petro | Surname: Shramko | ||||||
| Date of birth: 20.09.1975 | Place of birth: Kiev | ||||||
| Permanent address: Kiev, Ukraine | |||||||
| Passport (OVIR): KC 530750 | Place of issue: Kiev | Date of issue: 29.04.1999 | Valid until: 29.04.2009 | ||||
| Seaman’s book: AB 323419 | Place of issue: Mariupol | Date of issue: 12.12.2006 | Valid until: 12.12.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Single | ||||||
| Next of kin: (name, pas. No) | . | ||||||
| Supported children under age of 18 | . | ||||||
| (name, surname, date of birth) | . | ||||||
| Knowledge of English language | Good | ||||||
| Education: | Qualification: | No Diploma: | Date of Issue: | ||||
| Kiev State Academy of Water Transport | Navigator | --- | 06.07.2001 | ||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 00165/2002/07 | Nikolaev |
06.08.2002 |
--- |
| Endorsement STCW | 00165/2002/07 | Nikolaev |
20.08.2002 |
02.07.2007 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00166/2002/07 | Nikolaev |
06.08.2002 |
--- |
| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00166/2002/07 | Nikolaev |
06.08.2002 |
02.08.2007 |
| Radar Observation and Plotting (A-II/1,2) | R 0037/02 | Kiev |
02.08.2002 |
02.08.2007 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | A 0060/02 | Kiev |
07.08.2002 |
07.08.2002 |
| Advanced Fire Fighting (A-VI/3) | F 0065/02 | Kiev |
24.07.2002 |
24.07.2007 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | S 0083/02 | Kiev |
13.07.2002 |
13.07.2007 |
| Medical First Aid (A-VI/4-1) | MA 0034/02 | Kiev |
12.07.2002 |
12.07.2007 |
Sea Service (during five last years):
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Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Ivan Akulov | Ukrtechflot |
3000 |
Ukraine |
Dry Cargo |
3-rd Off. |
25.12.2003 |
15.07.2004 |
| Danapris 4 | CSC |
3000 |
Ukraine |
Dry Cargo |
2-nd Off. |
03.03.2006 |
30.06.2006 |
| Experience at sea: Since 2001 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | # | Issued: | Place: | Exp. date: |
| Vaccination for cholera valid until: | Vaccination for yellow fever valid until: 20.10.2013 | |||