Address/Telephones. Documents and certificates. Date of issue. Sea Service during last five years (count backwards). Vessel’s. Main engine. Ship-owner/Manager

Foto

SEAMAN’S EMPLOYMENT APPLICATION FORM

Position applied for:		motorman	Second choice (if any):	Available from:
Family name:	Ivchenko			First name:	Oleksandr

Personal particulars

Date of birth:	03.02.1993	Place of birth:	Ukraine Odessa city	Nationality:	Ukraine
Marital status:	single	Color of hair:	black	Color of eyes:	Grey
Height (cm):		Weight (kg):		Size:		Shoes:

Name of father:___ Nicholas __________ Name of mother:____ Natalia _________ Name of spouse:__---___

Children under 18 (name/date of birth):__________________-----_______________________________________________

Home address: Dobrovolskogo 126 ap 212

Telephones: 0938792280 7114998

Next of Kin: Surname____Ivcenko____Name_____ Natalia______ Relationship____0930177108___

Address/Telephones

The same Dobrovolskogo 126 ap 212

E-mail: Sashau4@breezein.net

Documents and certificates

Documents

Place of issue

Date of issue

Valid until

Seaman’s passport

AB 529930

Illichivsk

06.05.2014

06.05.2019

Civil travel passport

EX832353

Odessa

05.12.2013

05.12.2023

Civil passport

KM596766

Odessa

06.05.2009

ID № KM596766

Certificates of Competency	Grade	No	Place of issue	Date of issue	Endorsement valid until
National	motorman	10122/2014/01	Izmail	18.03.2014

Name of Marine School (Academy):_____________________________________________________ Graduated on _______

STCW Certificates	No	Date of issue	Valid until
Basic safety/survival at sea	16589/2012/AT Izmail	04.12.2012	04.12.2017
GMDSS
ROPS, ARPA
Advanced fire-fighting
Proficiency in survival craft	3500/2014-A Illichivsk	25.02.2014	25.02.2019
Basic training for oil and chemical cargo	3577/2013-A Illichivsk	22.11.2013	22.11.2018
Dangerous cargo (Hazmat)
Security officer
Safety officer
Yellow fever
US VISA

Sea Service during last five years (count backwards)

Rank

Vessel’s

Main engine

Ship-owner/Manager

From
(mm.yy)

To(mm.yy)

Name Flag Type DWT Type HP motorman PATRIOT UKR Tug Diesel 3000 KvM Ltd Tecom leasing 04.04 21.06 seaman PATRIOT UKR Tug Diesel 3000 KvM Ltd Tecom leasing 01.09 31.10

Наличие справок о плавании и отзывов о работе приветствуется

Notes:

Signature ______Ivchenko_______________________ Date 14.05.2014

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