In accordance with seaman s book in English Language

APPLICATION FORM

1.Position

Cook-A/B

2.Filled

3.Ready

…….2009

In accordance with seaman s book in English Language
4.Surname	Shevchuk	5.First name	Ruslan
6.Father name	Ivanovych	7.Citizenship
8.Date of birth	04.04.1975	9.Place of birth	Ukrainian
10.Nationality	Polish	11.Religion	-

12.Phone’s

[phone];[phone].

[e-mail]

E-mail

13.Marital status

Single

14.Personal details

Hair brawn

Eyes blue

Height

Weight

Headdress

Shoes size 41

Overall size 48

18.Distinduish marks

15.Children’s

-

16.Next of kin address

Liverinova Olga, Ukrainian, Odessa rig., Izmail, Nahimova 98a

(apartment, building, street, city, region, postal zone, country)

17.Agency remarks

Expected Wage

19.English

FLUENT

GOOD

Х

FAIR

BASIC

Ukrainian Passports and Medical documents

Document	20.Number	21.Issued	22.Valid	23.Issuid Place
Travel passport	KC 197522	17.11.1999	17.11.2009
Seaman’s book	AB 350766	12.05.2006	12.05.2011
Medical Fitness		21.11.2008	21.11.2009
Drug and alcohol		21.11.2008	21.11.2009
Yellow fever		20.12.2001	20.12.2011

Previous sea service

24. Name of vessel

25.Flag

26. Type

27.Dwt

28.Engine

29. HP

30. Owner

31.Rank

32.From

33.Till

NORD

Antilles

Coster

Orion

Cook-A/B

04.12.08-21.02.09

URANUS

Antigua & Barbuda

Container

Heinz Corleis KG

Ch. Cook

16.12.07-25.02.08

EPIPHANY

Nassau Bahamas

Bulk Carrier

Anbros Maritim e S.A.

Ch. Cook

09.05.07-20.09.07

ALSEN

Cyprus

Coster

Marlow Navigat ion

Cook-OS

03.06.06-28.10.06

OELAND

Cyprus

Coster

M/N

Cook-A/B

03.10.05-23.03.06

URSA

D.P.R. Korea

General dry cargo

Unique Internat ional Holding LTD

Cook

05.10.04-28.03.05

TROY

Willemstad

General dry cargo

Smyrna Shipping

Cook-A/B

07.03.04-06.07.04

Flag state passports, Licenses visas and other documents

33.Document name / Details

34. Number

35. Issued

36.

37.

1.Seaman’s book (Cyprus)

CY 087601

..09.2005-..09.2015

2..Seaman’s book (Antigua and Barbuda)

23.12.2007- 23.12.2012

Ukrainian STCW-78/95 and other certificates
	Document	38.Number	39.Issued	40.Expirc	41.Issued Place
	Basic Safety Training	16073U	07.11.2006	07.11.2011
	Proficiency in Survival Craft	08034U	09.11.2006	09.11.2011
	Proficiency in Fast Rescue Boats
	Advanced Fire Fighting
	Medical First Aid
	Medical Care
	Dangerous & Hazardous Cargoes	19928 IZ	06.09.2005	05.09.2010
	Hazardous materials
	Ships Safety Officer
	Spesific Security Duties of Shipboard Personnel	4448 IZ	27.04.2007	26.04.2012
	Isolating Breathing Apparatus
	Bridge Resources Management
	ISM code
	Certificate Ship’s Cook	00226/2006/01	26.05.2006
	Endorsement Ship’s Cook	00226/2006/01	29.11.2006	29.11.2011
	Qualified Seaman Certificate	00390/2005/01	01.08.2005
	Endorsement Able seaman	00390/2005/01	29.11.2006	29.11.2011

Дата добавления: 2015-08-27