CRW13 – APPLICATION FOR EMPLOYMENT

Applied Company:
Personal Data
First Name Middle Name Last Name / Surname
Maksym Oleksievich Kovalenko
Nationality Date Of Birth (dd/mm/yy) Place of Birth
Ukrainian 06/02/75 Ukraine
Position Applied For 3rd eng. Female × Male Available date 07/06/2024

Home Address Personal Documents Issued on Valid until

Passport (Country / Number) Ukraine / FJ 505872 25.10.2027
74/1,Dnepropetrovskay road
str.,apt.33, Odessa, Ukraine, Seaman’s book AB 670086 14.01.2026
65069
USA C1/D visa 2017347356001 12.12.2027

Telephone +380660002497 Schengen Visa FJ 505872 25.10.2027

E-Mail [email protected] Medical Fitness Certificate 460 04.04.2026

National Certificates of Competence Tanker Endorsements

country__Russia________________ Management level Operation level
Grade Issued Expires Oil Chemical Gas
2-nd Cl. Engineer 12.11.2020 06.10.2025

Valid Flag State Liberia , Panama , Malta , Marshall Islands , UK , Singapore Norway (NIS) ,
Endorsements Italy Other (list flags)
GMDSS Flag State GMDSS Endorsements (list)
General /Restricted

Other valid certificates and training attended

×Basic Safety Training × Advanced Fighting × Medical First Aid Medical Care ECDIS (Generic)
Ship Security Officer Bridge Team Management Ship Handling Liquid Cargo Handling
× ER Management ECDIS (Type Specific) × Other (specify)

Education History: Name of Institution / Level / Graduate Date: Sakhalin Higher Marine School / bachelor / 26.06.1995

Please answer the following questions:

 Did you suffer, or presently suffer from, any disease likely to render you unfit for services at
sea or likely to endanger the health of other persons on board?
If yes, please provide details _______________________________________________ YES × NO
______________________________________________________________________

 Did you suffer any accident, which rendered you temporary and/or partially disabled? YES × NO
 Did you ever undergo psychiatric treatment YES × NO
 Are you addicted to alcohol or drugs of any kind? YES × NO
I hereby declare that the above facts and information are true and accurate. I further consent to the holding and processing by (i) the owners of any vessel on which I may
be assigned from time to time and (ii) the Managers and any direct or indirect parent or subsidiary or associated or affiliated company of the Managers (together referred to
as "the Companies") for the purposes of my employment, of personal data about me contained herein, or provided to any of the Companies at a later date, including with
respect to personal and pensions administration, employee management and as required to comply with any laws, regulations or contracts applicable to any of the
Companies or their businesses. I understand that this data will be stored in the Managers’ database for the purposes of my current or future employment arranged by the
Managers. Further, I confirm that the above may involve the transfer of my personal data within the Managers’ organization .

Place______Varna_____________ Date___07.06.2024_______________ Signature_____ _______

For Office Use Only
Initial assessment of applicant for further recruitment
Comments

Responsible person

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Name / Signature _______________________________________________ Date ________________________________

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Sea Experience : (List the most recent experience first; use additional sheets as required)
Main Engine Date From Date To Reason for
Company Flag Vessel Name Type (1) GRT DWT (2) BHP Rank
(dd/mm/yy) (dd/mm/yy) S/off (3)
Anglo International UK 64100 114727 MAN B&W 3eng 10.10.23 17.12.23 Change
Anglo Marie Louise B/C 18182 management
Shipping 6S60MC-C7
Anglo Eastern Ship HKG Saga Falcon 37499 55596 MAN B&W 12819 3eng 21.12.22 12.05.23 EOC
Management Ltd. G/C 5S60ME C-
MARK 8.2
ISHIMA Pte. Ltd LUX Medi Zuoz B/C 34049 60501 Kobe Diesel 9734 3eng 16.06.22 18.10.22 EOC
6UEC50LSH-
Equinox Maritime Ltd. CYM Equinox Star B/C 33232 58680 Eco-C2
MAN B&W 9842 3eng 12.12.21 05.05.22 EOC
6S50MC-C MK-
Anglo Eastern Ship MHL Baltic Wasp B/C 36353 63389 MAN B&W 10795 3eng 23.04.21 19.10.21 EOC
Management Ltd. 5S60ME C-
SMT Shipping Poland BHS B&W 6S50MC- 3eng 15.02.20 22.06.20 EOC
Poland Pearl B/C 27428 45474 9160
sp. z o.o. C8.2

(1)
Use only the following abbreviations for vsl types:
*Please use only following abbreviations for the vessel type: (2)
Engineers to give make/model of engines, e.g. “MAN
GCD General Cargo MLP Multi-Purpose B/C Bulk Carrier CON Container O/O Ore Oil OBO Ore/Bulk/Oil 14V52/55A” or “SULZER 5RTA58”
(3)
TNC Tanker Crude TNP Tanker Product TNV VLCC/ULCC CHM Chemical Tanker LPG/LNG Gas Tanker FSO / FPSO Reason of Sing Off, e.g. “EOC – End of Contract”,
PAS Passenger Ship R/O Ro/Ro DRG Dredger NVL Naval Ship H/L Heavy Lift “MED – Medical Ground”, “OWN – Own request”
OSV Offshore Supply SRV Survey vessel LOG Log/Timber SSHL Semi-Submergible MOB Mobile Offshore Unit
Please provide details of two recent employers who
we may contact for references
Name of V.Ships Ltd. Anglo Eastern Ship
Company Management Ltd.
Name of Anglo Marie Louise Saga Falcon
person
Address to

Telephone/E- +35725848400 +85228636111

Mail

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