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Application form / personal data.
Surname:
| Kolesnikov
| Sergiy
| | | Photo
| | Date of Birth:
| 20121988
| Place of Birth / City & Country:
| | Nationality:
| | Ukraine Odessa
| | Ukraine
| | Permanent address:
| Nekrasova 6/11
| Phone(home):
| |
| | | | | Height:
|
| Colour of eyes:
| grey
| Mob. Phone:
| |
| | Weight:
|
| Colour of hair:
| ruso
| e-mail:
| | | | Civil Status
| Married
single
divorced
| Next of kin
| | Address next of kin:
| | Kolesnikova Ludmila
| | Nekrasova 6/11
| | | | | Nbr of Children:
| no
| Name:
| | | Nearest airport:
| Odessa
| | POSITION: AB
| | Phone: 0668662982
| | DOCUMENTS
| NUMBER
| WELDER: Yes No
| VALID
| | COUNTRY, CITY
| | NATIONAL PASSPORT
| Km314138
| ISSUED
| | Ukraine
| | Ukrain
| NATIONAL SEAMAN’ S BOOK
| Ab504412
| 23/09/2005
| 10/10/2017
| Ukraine
| | | LICENSE ____________(GRADE)
| | 10/10/2012
| | | | | SOLAS
| | | | | | | PROF. IN SURVIVAL CRAFT
| 3/044/12
| | 07/02/2017
| Ukraine
| | | ADVANCED FIRE FIGHTING
| 0413/2013
| 07/02/2012
| 01/03/2018
| Ukraine
| | | MEDICAL FIRST AID
| 0230/2013
| 01/03/2013
| 27/02/2018
| Ukraine
| | | MEDICAL CARE
| | 27/02/2013
| | | | | HEALTH CERTIFICATE
| | | | | | | YELLOW FEVER VACCINATION
|
| | 21/02/2018
| | | | USA VISA
| no
| 21/02/2008
| | | | | GMDSS
| | | | | | | RADAR OBS
| | | | | | | ARPA
| | | | | | | SSO
| | | | | | | OTHER S’BOOK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | SEA SERVICE:
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