APPLICATION FORM NO.. TEL: +038(048)7315747, 7315748, 7117688; FAX: +038(048)496688. Bobenko Denys Vyacheslavovich. Ukraine. Odessa. Able Seaman. USA VISA. Odessa. Odessa. Odessa. Ak.Glushko str. 5A,apt 30 Tel.:0675953396 Tel.: +380631570856. Filonova Vik

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APPLICATION FORM NO.

TEL: +038(048)7315747, 7315748, 7117688; FAX: +038(048)496688

PHOTO

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SURNAME – NAME – PATRONYMIC

Bobenko Denys Vyacheslavovich

DATE OF BIRTH

29. 11. 1982

PLACE OF BIRTH

HEIGHT

WEIGHT

NATIONALITY

Ukraine

Odessa

RANK APPLYING FOR

Able Seaman

KNOWLEDGE OF ENGLISH

Poor

USA VISA

№ till

CREW NATIONALITIES

PASSPORTS &

SEAMAN’S BOOKS

TYPE

№

PLACE OF ISSUE

DATE OF ISSUE

DATE OF EXPIRY

NATIONAL

КК508934

Odessa

29. 08. 2000

––––––––––

SEAMAN’S ID CARD

АВ559787

Odessa

12. 11. 2015

12. 11. 2020

FOREIGN (ОВИР)

PO327919

Odessa

26. 08. 2016

26. 08. 2026

MIN SALARY 1300

PERMANENT ADDRESS

& PHONE №

Ak. Glushko str. 5A, apt 30 Tel.: 0675953396 Tel.: +380631570856

SECOND ADDRESS &

PHONE №

NAME, PHONE № & ADDRESS OF THE NEXT KIN

Filonova Viktoriia Tel. 0679383375 0631817517

NAME OF THE HIGHER EDUCATIONAL INSTITUTION

LAST ATTENDED AND QUALIFICATION ATTAINED;

DATE OF STARTING – DATE OF GRADUATING

Odessa professional college of maritime transport 2011 Seaman 11january2011

CERTIFICATES OF COMPETENCY AND STCW 78/95 CERTIFICATES HELD

NAME OF THE COC. OR STCW CERTIFICATE

COC NO. OR STCW

CERTIFICATE NO.

PLACE OF ISSUE

DATE OF ISSUE

DATE OF EXPIRE

ADVANCED FIRE FIGHTING

17 459

Illichivsk

12. 10. 2015

12. 10. 2020

PROFICIENCY IN SURVIVAL CRAFT

23 051

Illichivsk

12. 10. 2015

12. 10. 2020

SEFETY FAMILIARIZANION, BASIC TRAINING AND INSTRUCTION FOR ALL SEAFARERS

27 965

Illichivsk

12. 10. 2015

12. 10. 2020

TANKER FAMILIARIZATION

Illichivsk

12. 10. 2015

12. 10. 2020

SEA SERVICE IN THE LAST FIVE YEARS

FLAG	COMPANY, TELEPHONE	VESSEL NAME	VESSEL TYPE	DW IN TONNES	MAIN ENGINE & POWER IN KWT	RANK	FROM	TO
Moroni /The Union Of Comoros	South SeaServices, S. A	Careon	Refeer			OS (helmsman)	29. 04. 2009	20. 11. 2009
Freetown	Sierra fishing co.	Ice louise	Refeer			AB(helmsman)	03. 05. 2011	31. 01. 2012
ST. KITTS AND NEVIS	“ Sea Traffic Shipping Co”	Don star	Bulker			AB(helmsman)	12. 10. 2012	28. 01. 2013
iran	Parsian sea golden shipping co	Saman	General cargo		2 *970	Ab	05. 07. 2013	07. 01. 2014
Liberia	Sila Shipping LTD	Sila	General cargo			Ab
Liberia	Xian Shipping LTD	Xian	Bulk carrier			Ab
Valletta	Coronis Shipping Company S. A.	Alycia	Bulk carrier			Ab
Valletta	Thetis Shipping Company LTD	Althea	Bulk carrier			Ab

I UNDERSTAND THAT MY CONTRACT MAY BE TERMINATED WITHOUT NOTICE IF ANY OF THE ABOVE GIVEN INFORMATION IS FALSE.

DATE: ____________________ SIGNATURE: _________________________________