SEAFARER’S APPLICATION FORM

1^ST CHOICE: O\S

2^NDCHOICE: O\S

SURNAME: Tkachuk

FIRST NAME: Vadym

MIDDLE NAME: Oleksandrovich

DATE OF BIRTH: 20/09/1987

PLACE OF BIRTH: Mluniv, Rovno reg

CITIZENSHIP: Ukraine

PERMANENT ADDRESS: Ukraine, Volun,Polapu156

AVAILABLE FROM

10/02/2015

PHONE (HOME): [phone]

PHONE (MOB.): [phone]/[e-mail]

NEAREST AIRPORT: Kuiv

MARITAL STATUS (Married / Single / Divorced): Married

NUMBER / AGE OF CHILDREN: 1/ 2

NEXT OF KIN (NAME / RELATION): Tkchuk Svitlana

NEXT OF KIN (ADDRESS): Same as above

COLOUR OF EYES: brown

COLOUR OF HAIR: black

SPECIAL MARKS: nil

HEIGHT: 182 CM

WEIGHT: 71 KG

OVERALL SIZE: 58

SHOES SIZE: 43

KNOWLEDGE OF ENGLISH (Fluent / Good / Satisfactory / Poor): Good

OTHER LANGUAGES: Nil

LICENSES & CERTIFICATES HELD	№	DATE OF ISSUE	DATE OF EXPIRY	PLACE OF ISSUE
CERTIFIKATEof awarding of trade qualification		10/03/14		Mariupol
CERTIFICATE OF PROFICIENCY	10298/2014/06	27/05/2014		Mariupol
SEAMAN’S PASSPORT РРЖИМЯZXXCCVBBN N NM MMMNMJNJ	АВ449323	27.03.2014	27.03.2019	Mariupol
TRAVEL PASSPORTKJJJJMNJJNCCSZX	ER250385 FDNCB	06/03/2014	06/03/2024	Mariupol
Security-related training and instruction for all seafarers	0837/2014	19/03/14	19/03/19	Mariupol
Proficiency in survival craft and rescue boats other than rescue boats	0471/2014	19/03/14	19/03/19	Mariupol
Safety familiarization,basik training and instruction all seafarers	0621/2014	19/03/14	19/03/19	Mariupol
Certifikate dangerouse and hazardous substances	4491 KC	06/06/14	06/06/19	Mariupol

GRADUATED FROM:

YELLOW FEVER (Date of Vaccination): 03/06/2014

LAST MEDICAL EXAMINATION (Date of Expiy / Med Centr): /

DETAILS OF PREVIOUS SEA SERVICE
RANK	COMPANY	FLAG	NAME OF VSL	TYPE OF VSL	TYPE OF ENGINE	DWT	BHP	FROM	TO
O/S	Viktoria oceanway ltd	Panama	Soul of luck	Container	MAN B&W			10/06/14	10/02/15

SIGNATURE

Дата добавления: 2015-07-26