Юрий

Application Form for
Id No.
RANK:
AB Cook

Full Name: (as shown in passport)
YURIY GORBENKO

Date and Place of birth:
13.06.1972

Marital Status:
mr.

Home Address:
Украина г.Одесса ул. Добровольского 129. кв 9 индекс 65025
Home Phone/Fax/e-mail
[відкрити контакти](див. вище в блоці «контактна інформація») e-mail: [відкрити контакти](див. вище в блоці «контактна інформація»)
Next Relations And Kin's /Name/Phone

Language / Knowledge
Marlins Test
Other test:
Height:
180
(English)
Result:

Result:

93
Other language ( )
Speaking:

Writing:

45
Academic Qualification
Name of institution:
Qualification:

Year of graduation:

Details of License and Seafarers Documents
GRADE
NUMBER
ISSUED
EXPIRY
Identity/Travel Documents

Seaman's Passport

AB522533
19.03.14
10.08.23
Travel passport

FJ812280
01.11.2017
01.11.2027
Seaman s Passport Republic of Liberia

№1255911
08.02.16
08.02.21

VISA USA

12.O3.2O21
1O.O3.2O31

Seaman's Book(if applicable)

№01565\2013\24
20.03.2013

Yellow Fever Vaccination

18.07.2011
18.07.2021
Drug &Alcohol Test

AB

№12594\2015\08
01.07.2015

Cook

№03848\2018\08
14.11.2018

Endorsement

Basic Safety Training

№169949
20.07.20
20.07.25
GMDSS

GMDSS Endorsement

ON BESIC TRANNG FOR CARGO OPERATIONS ON TANKERS

№02736\2020\08
31.08.20
12.08.25
Ship Security

№4335
14.05.2018

Advanced Fire-fighting

Proficiency in survival craft, rescue boats

№170068
20.07.20.
20.07.25
Training for personnel serving on passenger ships

Advanced fire fighting

Proficiency in fast rescue boats

Proficiency in survival craft and rescue boats other fast rescue boats

Carriage of dangerous and hazardous substances

№14290
04.05.15
04.05.20

Sea-Service
FROM
TO
RANK
SHIP’S NAME
TYPE
OWNER
DWT
H.P.
M/E TYPE
08.04.08
10.09.08
AB
ARIEL-S
Т/х

3000

12.03.09
29.04.10
AB
DELAWARE
m/v

5000

25.04.12
20.10.12
AB
MERMAID PRAIDE
m/v

3000

28.05.13
18.01.14
AB
URLA
m/v

3332

05.06.14
09.02.15
AB
URLA
m/v

3332

25.01.16
18.08.16
AB
SOPHIA 1
M/V

12000

05,03,17
10,09,17
AB
HAMGAM
M/V

72149

25.12.17
02.07.18
OS
ARNIKA
M/T

99148

21.12.2018
29.03.2019
Cook
BDIN
M/T

116075

21.06.2019
27.06.20
Cook
MIRIAM B
M/T

116075

09.10.2020
16.01.2021
AB--COOK
MAXAL RAISE
М\V

3452

17.O4.2O21
24.O6.2O21
msm
UGALE
M\T

52642

;