1
************Oleksandr
created by
crewdata.com
SEAFARER'S APPLICATION FORM
http://crewdata.com (http://crewdata.com/)
Position:
ORDINARY SEAMAN
or DECK CADET
Readiness:
**********
Citizenship:
Ukraine
Last name:
************
Marital status
married
First name:
Oleksandr
Children:
Middle name:
Oleksandrovich
Nationality:
Ukrainian
Birth date:
**********
Birth place:
Ukraine
Home address:
Odessa, Ukraine
Phone mobile:
**************
Phone home:
Email:
****************
English level:
Average
Salary
Minimum:
400
Expected:
1000
Last:
$/month
Passports, Licenses & Certificates
Title
Class
Number
Place of issue
Issued
Valid
Passports & Visas
Civil passport
KM228033
Odessa, UKR
**********
Seaman's book
AB556553
Ilyichevsk, UKR
29.*************.2020
Travel passport
FE139875
Odessa, UKR
1**************2.2026
Diplomas & Endorsements
Certificate of Competency
Ordinary Seaman
12328/2015/07
Nikolaev, UKR
21.*************.2100
ON BASIC TRAINING FOR
CARGO OPERATIONS ON
TANKERS
17123/2016/08
Odessa, UKR
24.11.2*************1
Odessa National Maritime
Academy
Study to the present
Study to the
present
Odessa, UKR
**********
Odessa National Politechnic
University
Masters degree in
Automation and
control systems,
CK37601651
Odessa, UKR
2**************1.2100
Odessa National Politechnic
University
Bachelor's degree
in computer
systems of auto
CK34468102
Odessa, UKR
**********
Certificates & Licenses
Basic Safety Training (VI/1.1-4)
29572
Odessa, UKR
17.*************.2020
Proficiency in Survival Craft (VI/2)
5177
Odessa, UKR
*************.05.2020
Advanced Fire Fighting (VI/3)
4045
Odessa, UKR
*************.05.2020
SECURITY AWARENESS TRAINING FOR ALL
SEAFARERS
15106
Odessa, UKR
*************.08.2020
TRAINING FOR SEAFARERS WITH DESIGNATED
SECURITY DUTIES
26776
Odessa, UKR
*************.08.2020
BASIC TRAINING FOR OIL AND CHEMICAL
TANKER CARGO OPERATIONS
4085
R0056/2016
Odessa, UKR
*************.04.2021
Medical Certificates
Medical Fitness Certificate
Odessa, UKR
27.*************.2016
Yellow Fever Vaccination
Odessa, UKR
27.*************.2025
Sea-going experience
Vessel’s
name
Flag
Type
Engine
Rank
From
Shipowner
Year
DWT
HP
Till
Crew Agency
2
Kulchytskyi Oleksandr
created by
crewdata.com
1
BERILL
UKR
General Cargo
Deutz
Ordinary Seaman
**********
Snabsudoservice
1976
1600
570
**********
2
Khadzibey
UKR
Passenger Ship
Sulzer
Deck Cadet
**********
Odessa Marine Port
1984
83
840
**********
General Physical State
Height (cm)
Weight (kg)
Shoes
Clothes
Hair color
Eye color
190
87
46
XL
brown
green
Additional information
Date applied: **********
Signature: