CRW13 – APPLICATION FOR EMPLOYMENT

Personal Data
First Name Middle Name Last Name / Surname
Mykola Fedorovich Paskhin
AFFIX HERE YOUR
Nationality Date Of Birth (dd/mm/yy) Place of Birth RECENT PASSPORT
Ukraine 25.05.1962 Russia SIZE PHOTOGRAPH

Position Applied For Female + Male Available date

Home Address Personal Documents Issued on Valid until

Passport (Country / Number) 09.01.2018 09.01.2028
Ukraine FK619056
Seaman’s book 11.12.2017 11.12.2022
AB612697
USA C1/D visa 14.08.2015 12.08.2020

Telephone Schengen Visa

E-Mail Medical Fitness Certificate 03.06.2019 03.06.2020

nkolay.paskhin@gmail.com CA228-19

National Certificates of Competence Tanker Endorsements

country_______________________ Management level Operation level
Grade Issued Expires Oil Chemical Gas

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: Rybinsk secondary river school name Kalashnikov, 1981,
technician-electrical engineer
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__UKRAINE_________________________ Date 30.01.2020___________________________ Signature
Paskhin______________________________

For Office Use

Initial assessment of applicant for further recruitment
Comments

Responsible person

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 CRW13 – APPLICATION FOR EMPLOYMENT

Name / Signature _Paskhin ______________________________________________ Date

_30.01.2020_______________________________

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 CRW13 – APPLICATION FOR EMPLOYMENT

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)
Marloy Navigation Mell Singapore CON 9966 9730KW El-engineer 09.06.2011 16.10.2011
Marloy Navigation Asian Carrier CON 4450 4320KW El-engineer 17.01.2012 12.05.2012
Marloy Navigation BBC Maryland MLP 9627 5400KW El-engineer 12.08.2012 24.12.2012
Marloy Navigation BBC Vermont MLP 9625 5400KW El-engineer 29.03.2013 30.07.2013
Marloy Navigation BBC Vermont MLP 9625 5400KW El-engineer 20.11.2013 06.05.2014
Marloy Navigation BBC Plato MLP 9618 5400KW El-engineer 24.08.2014 12.12.2014
Marloy Navigation Frissian Pioneer CON 9966 9730KW El-engineer 07.03.2015 11.07.2015
Marloy Navigation CAJU B/C 17784 7100KW El-engineer 03.12.2015 16.05.2016
Marloy Navigation ARSOS CON 15375 11200KW El-engineer 27.10.2016 23.02.2017
Marloy Navigation ARSOS CON 15375 11200KW El-engineer 27.06.2017 08.11.2017
Marloy Navigation ARSOS CON 15375 11200KW El-engineer 02.03.2018 28.06.2018
Marloy Navigation ARSOS CON 15375 11200KW El-engineer 31.10.2018 28.02.2019
Marloy Navigation Pacific Trader CON 9957 9730KW El-engineer 04.07.2019 01.11.2019

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

Telephone/E-Mail

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