Application form

Surname: Perepelytsia

Position Applied For: 2 class Motormen /Engine Cadet

Given Name: Andrii

Minimum salary:

Father’s Name: Aleksandrovich

Marital Status: not married

Date/Place of Birth: 01.11.1994 Izym

Number Of Children: 1 boy

Citizenship: Ukrainian

Next Kin: Kryvoruchko Anastasiia

Address: 21 Tekstilna 6. Kherson

Relation:

Phone: +380*********

E-mail: ac7x5u@r.postjobfree.com

Next Kin Address: 21 Tekstilna 6. Kherson

readiness date:

Phone (Next of kin): +380*********

Name of School

City

Graduated

Type of Degree Received

Admiral Ushakov Maritime Institute

Kherson

15.01.2018-28.07.2018

Rating forming port of watch in engine-room

Passports:

Number / Place Of Issue

Issued

Valid

Seaman’s Passport:

AB 630190 Kherson

07.06.2018

07.06.2023

Travelling Passport:

FN575786 Kherson

26.04.2018

26.04.2028

Licenses

Grade

Number

Issued

Valid

National License:

Second class motorman

01884/2018/11

29.08.2018

Endorsement:

Certificate of competency

028752

28.07.2018

STCW Certificates

Issued

Valid

Safety familiarization, Basic training and instruction for all seafares

1814

07.03.2018

07.03.2023

Training In Carrying of Dangerous and Hazardous Sabstances

3545

31.08.2018

31.08.2023

Training of passenger ship personnel

933

27.07.2018

27.07.2023

Basic training for Oil and Chemical tanker cargo operations

1447

03.10.2018

03.10.2023

Proficiency in survival craft and rescue boats other than fast rescue boats

1277

09.03.2018

09.03.2023

Basic training for Liquefied gas tanker cargo operations

316

28.09.2018

28.09.2023

Advanced fire fighting

2836

18.05.2018

18.05.2023

Number

Issued

Valid

Medical Examination:

Drug & Alcohol Certificate:

Yellow Fever:

Weight: kg 65

Clothes: M

Shoes: 43

Height: cm 173

English Level: Intermediate

Vessel’s Name

Company

Flag

Type

DWT

Engine

BHP

Rank

Date On

Date Off

BURUN

Kherson part of waterways

KHERSON

Tug

583

1030

CADET

28.06.2018

27.08.2018

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