APPLICATION FORM

Rank Motorman/Oiler Date of birth 07/11/1999

Surname Tsyhanenko Place of birth Odessa, Ukraine
First name Dmytro Home address Bucharest, Romania
personal details

Patronymic Home phone Mobil +380501947033

Marital statu Single E-mail sangeika1999@gmail.com
Next of kin/relationship/address
Test Marlins Test Height 188 Clothes size 48 Hair color White
Language knowledge (english)
Result Result Weight 75 Shoes size 43 Eye color Blue
Education University (School, College) Year of graduation Speciality
Sertificate of profiency Odessa maritime lyceum 2020 Second class motorman
Junior specialist Marinesko Maritime Proffesional College 2023 Ships Engineering systems
Document Grade Number Place of issue Issued date Expire date
Seaman's book Ukraine AB 636158 PORT ODESSA 13.06.2019 13.06.2029
Documents

Passport (national) Ukraine 000010619 5140 09.02.2016 09.02.2026

Passport (foreign) Ukraine FT449768 5140 05.12.2018 05.12.2028
Visa (USA, others)
Seaman’s passport (Cyp., others) Cyprus CY 352347 Cyprus 13.12.2022 12.12.2032
CERTIFICATE OF COMPETENCY of 02378/2020/08 Odessa 11.08.2020
Safety Familiarization/, Basic training for all Seafarers32334224/01/1323/023 Odessa 11.10.2023 11.10.2028
Security Awereness Training for all seafarers 32334224/10/0512/023 Odessa 11.10.2023 11.10.2028
Designated security duties of shipboard personnel 32334224/09/0833/023 Odessa 11.10.2023 11.10.2028
SURVIVAL CRAFT & RESCUE BOAT 32334224/02/1057/023 Odessa 11.10.2023 11.10.2028
Certificates

ADVANCED FIRE FIGHTING 32334224/04/0918/023 Odessa 11.10.2023 11.10.2028

Training of passenger ship personnel 6/2022/117 Odessa 25.08.2022 25.08.2027
MEDICAL FIRST AIDS
MEDICAL CARE
SSO
PHYSICAL EXAMINATION REPORT Odessa 26.10.2023 26.10.2024
YELLOW FEVER 27298795 Odessa 16.09.2020
D & A TEST Odessa 26.10.2023 26.10.2024
HAZMAT/Carriage of dang.&hazard.subst.
Special training

HAZMAT training program "C", title 49 (USA)

Oil tanker training program
Chemical tanker training program
Other courses:

Type of vessel Owner's name Date Date

Name of vessel Flag Rank
DWT Crew management company from to
St.Vincent and The AHTS
Zakher Emperor Zakher Marine Oiler 15.10.2020 14.05.2021
Grenadines 1973
Drill ship
Mist 1 Liberia Anika Ventures Limited Oiler 29.06.2021 18.09.2021
60349
Previous experience for last 5 years

Drill ship
ENSCO DS4 Marshall Islands Valaris OIler 06.10.2021 28.10.2021
60162
Drill ship
ENSCO DS8 Marshall Islands Valaris OIler 29.10.2021 26.11.2021
57335
Tug
SL Macaloe Marshall Islands Smit Lamnalco OIler 15.01.2022 09.02.2022
1164
High speed craft
Ceuta Jet Cyprus FRS OIler 28.08.2022 04.10.2022
2273
High speed craft
Levante Jet Cyprus FRS OIler 27.10.2022 14.12.2022
5537
High speed craft
Levante Jet Cyprus FRS OIler 11.01.2023 02.05.2023
5539
AHTS DP2
Ievoli Grey Italy Marnavi OIler 18.07.2023 30.09.2023
2995
AHTS DP2
Ievoli Grey Italy Marnavi OIler 07.12.2023 07.03.2024
2995
Nationality of crewmembers sailed with: Your comments:
Remarks:

Recommendations min wage 2000$

Phone of last shipowner (Crew company) expected wage
Others: expect.duration
Application form eadiness to work
is accepted by Date 24.04.2024 Signature of applica