APPLICATION FORM. LAVRINENKO. MAKSYM. VALERIYOVICH. English: Normal. CERTIFICATE of COMPETENCY. CERTIFICATES

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Mob.: +38(050)162-18-11 / +38(095)793-73-67 E-mail: maks. L_1996@mail. ru

3ENG/MM

APPLICATION FORM

POSITION APPLIED FOR:

3ENG/MM

SURNAME

NAME

FATHER`S NAME

LAVRINENKO

MAKSYM

VALERIYOVICH

DАTE OF BIRTH

NEXT OF KIN:

MARITAL STATUS

19. 04. 1996/ Kherson / Ukraine

Lavrinenko Tatyana- Mother

Single

PLACE OF BIRTH

NATIONALITY

ADDRESS NEXT OF KIN:

Kherson / Ukraine

Ukraine

The same +38(095)793-73-67

ADDRESS:

1 Mira str., v. Radensk, Kherson reg., Ukraine

Visa USA

EDUCATION

Kherson Maritime College - Technical Engineer- 2016

English: Normal

PASSPORT

№

ISSUED PLACE

ISSUED DATE

VALIDE UNTIL

CIVIL PASSPORT

MP 373827

Kherson reg. /Ukraine

23. 07. 2012

Permanent

SEAMEN`S PASSPORT

AB 534863

Kherson/Ukraine

08. 08. 2014

25. 07. 2019

INTERNATIONAL PASSPORT

ES 165288

Kherson/Ukraine

29. 08. 2014

29. 08. 2024

Height:

Weight:

Shoes:

Size:

Color of eyes:

blue

Color of hear:

brown

CERTIFICATE of COMPETENCY

CERTIFICATE of COMPETENCY	ISSUED PLACE	ISSUED DATE	CLASS
12481/2015/11	Kherson/Ukraine	30. 07. 2015	Second Class Motorman
CERTIFICATE of COMPETENCY	ISSUED PLACE	ISSUED DATE	CLASS
13647/2016/11	Kherson/Ukraine	02. 08. 2016	Third-class engineer
ENDORSEMENT of COMPETENCY	ISSUED PLACE	ISSUED DATE	VALIDE UNTIL
13647/2016/11	Kherson/Ukraine	02. 08. 2016	30. 06. 2021

CERTIFICATES

CERTIFICATES	№	ISSUED DATE	VALIDE UNTIL	ISSUED PLACE
Basic safety training		25. 03. 2015	25. 03. 2020	Illichivsk/Ukraine
Advanced fire fighting		25. 03. 2015	25. 03. 2020	Illichivsk/Ukraine
Proficiency in survival craft and rescue boats		25. 03. 2015	25. 03. 2020	Illichivsk/Ukraine
Medical first aid on board ship		25. 03. 2015	25. 03. 2020	Illichivsk/Ukraine
Security – related training and instruction for all seafarers (6/1)		25. 03. 2015	25. 03. 2020	Illichivsk/Ukraine
Engine room resource management		11. 05. 2016	11. 05. 2021	Odessa/Ukraine
Medical Examination		11. 05. 2016	11. 05. 2017	Kherson/Ukraine
Yellow Fever		13. 05. 2015	13. 05. 2015	Kherson/Ukraine

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