APPLICATION FORM
PHOTO
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APPLICATION FORM
Desired salary: Negotiable
Position applied for:
| EL CADET
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/ OS / WELDER
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| Available from:
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01. 07. 2017
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| | Surname:
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VLADIUK
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| First name:
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SERHII
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| Second name:
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SERGIEVICH
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Date / Place of birth: 05. 09. 1988
| / RUSSIA
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Nationality: UKRAININ
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Mob. tel +380956963644 Skype: sergey64206 E-mail: vladiuk. serhii@gmail. com
Home address: Ukraine/ Kherson/ str. Petrenko № 79
Name of educational institution
| Number
| Year of entry
| Year of graduation
| Competency Grade
| Place of issue
| MARITIME COLLEGE OF KHERSON STATE MARITIME ACADEMY
| | 01. 09. 2016
| | EL
ENGINEER
| KHERSON
| SEAFARERS TRAINING CENTRE
| № 103795
| 10. 11. 2014
| 15. 04. 2015
| SEAMAN
| ODESSA
| SHIPBUILDING LYCEUM
| EX №3188101333
| 01. 09. 2006
| 30. 06. 2007
| WELDER
| KHERSON
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CERTIFICATES
| QUALIFICATION
| NUMBER
| Date of issue
| Place of issue
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| Certificate of Competency
| Second class seaman
| 12164/2015/11
| 14. 07. 2015
| Kherson
| Endorsement
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DOCUMENTS
| NUMBER
| DATE OF ISSUE
| PLACE OF ISSUE
| DATE OF EXPIRY
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Seaman’s book
| AB 563395
| 07. 09. 2015
| Kherson
| 18. 08. 2020
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International passport
| ER 443167
| 08. 04. 2014
| Kherson
| 08. 04. 2024
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Ukrainian passport
| MP 115597
| 01. 10. 2004
| Tsyurupinsk
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Health List
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| 14. 02. 2017
| Kherson
| 14. 02. 2018
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Drug & Alco Test
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| 14. 02. 2017
| Kherson
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Yellow Fever
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| 18. 09. 2015
| Kherson
| 18. 09. 2025
| Other countries
| Marshall Islands
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| | Liberia
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| Panama
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| | Others:
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Tax Number
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USA VISA
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SEA SERVICE FOR LAST 5 YEARS
№
| Name of vessel
| Flag
| Type
| DW
| KW
| Agency
| Rank
| From
| Till
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| 1.
| SIBIRSKIY 2132
| MORONI
| GENERAL CARGO
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| 1324
| SHIPPING CONSTRUCTION
TRADING LTD
| ABLE SEAMAN/WELDER
| 08. 03. 2016
| 01. 10. 2016
| 2.
| SIBIRSKIY 2132
| MORONI
| GENERAL CARGO
| 4477
| 1324
| SHIPPING CONSTRUCTION
TRADING LTD
| ABLE SEAMAN/WELDER
| 07. 04. 2017
| 01. 06. 2017
| 3.
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| KHERSON SHIPYARD/Ukraine
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WELDER
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| 4.
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CERTIFICATES AND QUALIFICATIONS
CERTIFICATE
| NUMBER
| Date of issue
| Expiration date
| Place of issue
| Designated security duties of shipboard personnel
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| 08. 04. 2016
| 08. 04. 2021
| Illichivsk
| Safety familiarization, basic training and instruction for all seafarers
| 16499/2015-a
| 10. 06. 2015
| 10. 06. 2020
| Odessa
| Proficiency in survival craft and rescue boats other than fast rescue boats
| 12753/2015-a
| 10. 06. 2015
| 10. 06. 2020
| Odessa
| Advanced fire fighting
| 10410/2015-a
| 10. 06. 2015
| 10. 06. 2020
| Odessa
| Ship’s welder
| 001763/17KH
| 30. 06. 2017
| 30. 06. 2019
| Kherson
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Height (cm):
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| Weight (kg):
| 82
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Color: eyes
| brown
| hair: black
| Size: overall
| 62
| shoe
| 44
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| | | Marital status:
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Not married
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Children: name
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no
| date of birth:
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| Father:
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Vladiuk Serhii Petrovich
| Address:
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OldMayachka Mob. tel: +380993732630
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