SEAFARER S APPLICATION FORM

*ST CHOICE: Second Class Seaman

2ND CHOICE: Deck Cadet

Surname: KRAVCHENKO

First Name: ROMAN

Middle Name: LEONIDOVICH

Date of birth: 28.12.1983

Place of birth: KHERSON

Min. Wage: Negotiable

Permanent address: KHERSON, UKRAIN, DEM YANA BEDNOHO str. 3 ap. 2

Nationality: UKRAINIAN

Nearest Airport: KHERSON, ODESSA, KIEV

E-mail: acwgdz@r.postjobfree.com

Phone (Home): +38 (0552) 32-17-20

Phone (Mob.): +38-050-***-**-**

SKYPE: NASTROMO5

Marital Status (Married, Single, Divorced): SINGLE

Next of Kin (Name / Relation): LEONID \ FATHER Tel: +38 (0552) 32-17-20

Address Next of Kin: KHERSON, UKRAINE, TYAGINSKAYA str. 3 ap. 2

Nbr of Children: NO

Colour of Eyes: GREEN

Colour of Hair: SALT/PEPPER

Height: 186 cm

Weight: 83 kg

Overall Size: L

Shoes Size: 44

Knowledge of English (fluent/good/moderate/poor): FLUENT

Other languages: SPANISH, UKRAINIAN, RUSSIAN

LICENSES & CERTIFICATES

Date of Issue

Expiry Date

Place of Issue

Certificate Of Competency

091207

26.02.2016

Unlimited

Kherson

National Certificate of Competency ( II/4 )

11362/2016/11

21.04.2016

Unlimited

Kherson

Seaman’s Passport

AB 573812

24.05.2016

05.05.2021

Kherson

Travel Passport

FC 398633

21.04.2016

21.04.2026

Kherson

Basic Safety

27034

27.07.2016

27.07.2021

Kherson

Proficiency in Survival Craft & Rescue Boats

22837

28.07.2016

28.07.2021

Kherson

Advanced Fire Fighting

6725

15.04.2016

15.04.2021

Kherson

Med. First Aid / Care

GMDSS

RADAR / ARPA

HAZMAT

Security Officer (ISPS Code)

Tanker (Basic oil chemical/ Spesialized)

Ro-Ro Passenger Ships

USA VISA, PANAMA, LIBERIA and other

Last Med. Exam. (Till): Blood group: B (III) Rh Yellow Fever (Till):

Graduated from : UKRAINE ODESSA MARITIME TRAINING CENTRE KHERSON BRANCH

Year: 2016

DETAILS OF PREVIOUS SEA SERVICE

RANK

COMPANY

NAME OF VSL

FLAG OF VSL

TYPE OF VSL

TYPE OF ENGINE

DWT

BHP

FROM

TO

Second Class Seaman

Shipyard of Kherson “ПАЛАДА”

“Астрахань” 2-020422

Ukraine

Floating crane

858

816

21.12.2015

20.02.2016

I HEREBY CERTIFY THAT ALL THE INFO CONTAINED HERE IN IS TRUE & CORRECT ANY MISREPRESENTATION WILL BE SUFFICIENT GROUND FOR DISQUALIFICATION & / OR ISMISSAL

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