Address:ul. Komarova 32, Kotlyrevo, Nikolaevskaya oblast, 57260, Ukraine

Photo

APPLICATION FORM

PERSONAL DESCRIPTION:

Rank: motorman	Surname: Brychko	Name: Valerii	Middle Name: Sergeevich
Date of Birth: 27.03.1980	Place of Birth: Ukraine	Citizenship: ukrainian	Marital Status: married
Address: ul. Komarova 32, Kotlyrevo, Nikolaevskaya oblast, 57260, Ukraine	Phone: [phone]
Next of Kin: mother, father	Address: Nikolaevskaya oblast, Ukraine	Phone: [phone]
ENGLISH: Intermediate	Total Experience: 4 years	Min.Salary: 300$	e-mail: [e-mail]

GENERAL DETAILS:

Documents	№	Issued	Valid Until	Place
National Passport	EO 193214	06.09.1996		Ukraine	Size: 52
Traveling Passport	ER 549051	24.04.2014	24.04.2024	Ukraine	Height: 168
Seaman’s Book	(national)	AB 531523	19.06.2014	19.06.2019	Ukraine	Shoes: 40
	Medic. cert.		28.03.2014	28.03.2015	Ukraine	Weight: 70

PRE-SEA EDUCATION:

Name of Marine School	Department	Graduated on
Nikolaev marine school	marine engineering	good

CERTIFICATES OF COMPETENCY:

	№	Grade	Place of issue	Date of issue/validity
National	10344/2014/07	Second class motorman	Ukraine	06.05.2014
Endorsement
GMDSS
Endorsement

STWS CERTIFICATES:

	№	Place of issue	Date of issue	Date of expiration
Basic Safety Training	7501 / 2014-A	Ukraine	26.03.2014	26.03.2019
Tanker Familiarization
Advanced Fire Fighting
Proficiency in survival craft course
Radar Observation & Plotting
Hazardous materials
Ships Safety Officer
Ships Security Officer

SEA SERVICE (DURING LAST FIVE YEARS)

№	Rank	Vessel’s Name	Vessel’s type/DWT	ME type/ HP	Company	Flag	From month/year	To month/year
1.	motorman	doker	tug	1700kWt	Nikolaev port	Ukraine	01/2014	15/2014
2.	motorman	zaharii	floating crane	D12D-A/339kWt	Dniproflot	Ukraine	08/2010	09/2014
3.
4.
5.
I, undersigned, confirm that all details provided on the form are correct. Signature: Date:



Дата добавления: 2015-11-04