SEAFAR
ER'S
APPLIC
ATION
FORM
AME Oleksand
r
URNAME Shpigalsk
yy
ATE OF 21.03.199
IRTH 1
LACE OF Nikolaev
IRTH
ATIONAL CONTACT
Ukranian 806********
TY PHONE
IVIL MOBILE
not 806********
TATUS PHONE
maried
EXT OF EMAIL ***************@****.**
IN
OME
DDRESS
OSITION AVAILABL
Deck
PPLIED E FROM
Cadet
OR
EVEL OF good USA VISA
NGLISH VALID
EA SERVICE RECORD FOR THE LAST 5 YEARS
RANK TYPE OF NAME OF FLAG GRT MAIN SHIPOWN SIGNED ON/ SIGNED OFF
VESSEL VESSEL ENGINE ER /
TYPE AND CREWING
POWER
Deck Tug BASHTA UKR 226 884kwt,,NIBULO 31.05.10 / 31.08.10
Cadet NSKYY N,,
Deck Passenge OM-106 UKR 152 440kwt MERiTIM 27.04.11 / 20.06.11
Cadet r vessel E
ACADEM
Y
Deck Tug BASHTA UKR 226 884kwt,,NIBULO 21.06.11 / 10.10.11
Cadet NSKYY N,,
Deck Tanker СБ-401 UKR 663 440kwt,,BIK,, 14.10.11 / 20.02.12
Cadet
Deck Dry cargo LARA SAINT 1948 1950kwt Чорномо 01.08.12 / 05.11.12
Cadet VINCENT рське
агенство
OCUME NUMBER ISSUED VALID COUNTRY
TS
ATIONAL EP28277 14.08.200 Ukraine
ASSPOR 7 7
ATIONAL AB43050 24.02.201 24.02.201 Ukraine
EAMAN’ 5 0 5
BOOK
ICENSE Ukraine
AVIGATO 02242/20 13.11.201 Ukraine
12/07 2
NDORSE 02242/20 13.11.201 31.12.201 Ukraine
ENT 12/07 2 6
AVIGATO
ASIC 20323/12 12.04.201 12.04.201 Ukraine
AFETY KH 2 7
RAINING
ROFICIE 15531/12 11.04.201 11.04.201 Ukraine
CY IN KH 2 7
URVIVAL
RAFT
DVANCE 9330/12K 06.04.201 06.04.201 Ukraine
FIRE H 2 7
IGHTING
EDICAL 7598/12K 21.03.201 21.03.201 Ukraine
IRST AID H 2 7
EDICAL
ARE
MDSS – 00192/20 22.06.201 31.12.201 Ukraine
ENERAL 12/07 2 6
PERATO
DVANCE
OIL
ANKER
ERTIFIC
TE
DVANCE
HEMICA
TANKER
ERTIFIC
TE
DVANCE
GAS
ANKER
ERTIFIC
TE
IL,
HEM.,
AS
ANKER
AMILIRIZ
TION
RPA, 2252/12K 12.04.201 12.04.201 Ukraine
ADAR H 2 7
BS
RIDGE
EAM
ANAGE
ENT
HIP’S
ANDLIN
HIP’S 07.08.201 07.08.201
ECURITY 3 8
FFICER
CDIS 1279/12K 16.03.201 16.03.201 Ukraine
H 2 7
ELLOW 28.03.201 28.03.202 Ukraine
EVER 1 1
ACCINAT
ON