Seafarer's application form

SEAFARER'S APPLICATION FORM

http://crewdata.com

Position:	COOK ASSISTANT	Readiness:	27.04.2015
Citizenship:	Ukraine
Last name:	MINZHYNER	Marital status	married
First name:	DMYTRO	Children:
Middle name:	STEPANOVICH	Nationality:	Russian
Birth date:	25.07.1993	Birth place:	Ukraine
Home address:	Izmail, Odessa reg., Ukraine, 68604	Phone mobile:	380(67)4239551
Phone home:	380(4841)53550
Email:	[e-mail]
English level:	Poor
Russian level:	Good

Salary

Minimum: 700

Expected: 1000

Last:

$/month

Education
Educational institution	Speciality	Faculty	Place	Number	From	Till
Training Center "Ilyichevsk ship repair yard"	Ship's Cook	Ships cook	Ilyichevsk/UKR		17.03.2014	22.08.2014

Passports, Licenses & Certificates
Title	Class	Number	Place of issue	Issued	Valid
Passports & Visas
Civil passport	KM646654	Izmail, UKR	22.02.2010	01.01.2100
Seaman's book	AB535528	Izmail, UKR	15.10.2014	15.10.2019
Travel passport	ES118199	Izmail, UKR	19.08.2014	19.08.2024
Diplomas & Endorsements
Certificate of Competency	4rd		Illichivsk, UKR	26.08.2014	01.01.2100
Certificates & Licenses
Basic Safety Training (VI/1.1-4)		Illichivsk, UKR	08.09.2014	08.09.2019
DESIGNATED SECURITY DUTIES OF SHIPBOARD PERSONNEL		Illichivsk, UKR	08.09.2014	08.09.2019
SHIP'S COOK	11611/2014/01	Izmail, UKR	25.09.2014	01.01.2100

General Physical State
Height (cm)	Weight (kg)	Shoes	Clothes	Hair color	Eye color
			XXXL	blonde	blue

Date applied:

27.04.2015

Signature:

Дата добавления: 2015-11-04