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APPLICATION FOR EMPLOYMENTRECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE
Rank Ch Mate First
Name Tahir Last Name Kapisazovic Nationali
ty MontenegroDate & Place
of Birth: 30th July 1966. Podgorica Marital Status: MarriedPresent
Address:Popovici bb, 85000 Bar, Montenegro Next of Kin: Wife
Home phone: +382 30 344 240 Name / Relationship: Dzenana / Wifecell phone: +382 69 594 060
Address: Popovici bb, 85000 Bar - MONTENEGROFax: +382 30 344 240
Email: [email protected] Next of kin Cell Phone : +382 69 611 380Father’s name Seko Mother’s name: Garajfila
Nearest Airport: Podgorica Km from
Airport: 50 Present Employer: Mediterranean Shipping Company SA
Languages: English, Italian Tel + email: +39 081 [email protected]
Medical Certificate issued: Private clinic Expired: 31/12/2012. Previous
Employer: -
Any visa issued: USA- C1/D Expired: 30/08/2013. Tel + email:Weight(kg
) 91 Height(cm) 186 Coverall Size: 62 Shoes Size: 43 Hair: Bro
wn Eyes: Brown
Position Applied: Master Date of availability: 01st August 2015Education: high/secondary school (4 years) , Nautical college (4 years)
Last wage (inclusive of leave pay): 6200€
Licence (Certificate of Competency)Licence Country Grade of Licence Number Place & Date Issued Date ExpiredMontenegro Master 02-1822 Bar, 23/04/2010. 23/04/2015.Panama Master CTB401451 NI Napoli, 20/09/2010. 23/04/2015.
Passports – If several passports write them all.Number Place Issued Date Issued Date Expired
P94AF0909 PJ Bar 29/05/2008. 29/05/2018.
Seaman’s Book - If several seaman’s books write them all (even if expired)Country Place Issued Date Issued Number Date ExpiredMontenegro Bar 04/03/2011. 85/2011 04/03/2021.Panama Napoli 09/10/2015. CTC134422 07/05/2020.
DP Log BookCountry Place Issued Date Issued Number Date ExpiredNA
DP CertificatesCertificates Place Issued Date Issued Number Date ExpiredDP Basic (induction)
NA
DP Advanced NA
DP Limited NA
DP unlimited NA
Application Form Page 1 of 3
.01
APPLICATION FOR EMPLOYMENTRECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE
CertificateCertificates STCW Date Issued Place Issued Expiration
date License Number
Yellow Fever certificate 20/01/2009. Piran-Slovenia 20/01/2019. B5447
Helicopter Underwater Escape Training NA
Helicopter Landing Officer NA
MEDICAL (First Aid) VI/4 30/04/2015. Bar 30/04/2020 0404-404-1979/15
MEDICAL (Care) VI/4 30/04/2015. Bar 30/04/2020 0404-404-1980/15
ARPA 06/01/2001. Kotor Unlimited 0038701RAA
GMDSS IV/2 07/05/2015 Kotor 07/05/2020 0405-403-3365/15
Advanced Fire Fighting VI/3 30/04/2015 Bar 30/04/2020 0404-404-1982/15
PSCRB (proficiency in survival craft) VI/2 30/04/2015 Bar 30/04/2020 0404-404-1981/15Basic Safety Training Certificate (or Items from 1 to 4 below MANDATORY) VI/1 30/04/2015 Bar 30/04/2020 0404-404-1978/15
1 - Personal Security and Social Responsibilities -II- -II- -II- -II-
2 - Personal Survival Technique -II- -II- -II- -II-3 - First Aid at sea -II- -II- -II- -II-4 - Fire fighting -II- -II- -II- -II-BOSIET
SSO (Ship Security Officer) VI/5 17/01/2014 Bar 17/01/2019 0404-404-141/14
Dangerous Cargo Handling 30/04/2015 Bar 30/04/2020 0404-404-1983/15
Oil and Chemical Tanker Cargo operations 30/04/2015 Bar 30/04/2020 0404-404-1984/15
Liquefied Gas Tanker Cargo Operation 30/04/2015 Bar 30/04/2020 0404-404-1985/15
ECDIS 16/01/2014. Kotor Unlimited 135/2014Certificate for seafarers with designated security duties 28/01/2014 Bar 28/01/2019 0404-404-452/14
Leadership and team-working skills 22/08/2014 Kotor Unlimited 676/2014
Ship bridge resources management 29/08/2014 Kotor Unlimited 197/2014
Pilot of port Bar 07/06/2008 Bar Unlimited 232/2
Application Form Page 2 of 3
.01
APPLICATION FOR EMPLOYMENTRECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE
Previous Sea Experience
Vessel’s Name Flag GRT Vessel Type
Eng Type & KW Company Name Rank Period:
FromPeriod:
To
For Offshore Ships: Type of Job Performed (supply, anchorhandling, towing…), Water Depth, Type of
Rig or Barge Work With, Area of Operation, Charterer-Client
MSC TERESA Panama
153115
Container 14200 TEU
98280 Mediterranean Shipping Company
Ch Mate 29/08/2015 02/02/2016
CONTAINER – W/W
MSC STELLA Panama
73819 Container 6700 TEU
69439 Mediterranean Shipping Company
Ch Mate 08/11/2014 17/04/2015
CONTAINER – W/W
MSC ALEXA Panama
42307 Container 3200 TEU
26350 Mediterranean Shipping Company
Ch Mate 18/03/2014 23/07/2014
CONTAINER – W/W
BOKA BAY Montenegro
260 Tug Boat 1852 Boka Pilot & Tug service
Master 03/02/2014 12/03/2014
TUG BOAT – TUG BOAT SERVICES
BOKA BAY Montenegro
260 Tug Boat 1852 Boka Pilot & Tug service
Ch Mate 10/01/2014 03/02/2014
TUG BOAT- TUG BOAT SERVICES
MSC VITTORIA Panama
89954 Container6200 TEU
68640 Mediterranean Shipping Company
Ch Mate 05/09/13 05/01/2014
CONTAINER – W/W
MSC LUISA Panama
75590 Container6200 TEU
77600 Mediterranean Shipping Company
Ch Mate 07/01/2013 01/06/2013
CONTAINER – W/W
MSC ASYA Panama
107849
Container9200 TEU
69439 Mediterranean Shipping Company
Ch Mate 21/04/2012.
18/09/2012.
CONTAINER – W/W
MSC MARIA ELENA Panama
107849
Container9200 TEU
69439 Mediterranean Shipping Company
Ch Mate 02/08/2011.
10/12/2011.
CONTAINER – W/W
MSC ANS Panama
54304 Container5600 TEU
55890 Mediterranean Shipping Company
Ch Mate 04/09/2010.
23/02/2011.
CONTAINER – W/W
MSC MONICA Panama
37398 Container3400 TEU
33300 Mediterranean Shipping Company
Ch Mate 22/10/2009.
04/04/2010.
CONTAINER – W/W
MSC ANTONIA Panama
22667 Container1900 TEU
16980 Mediterranean Shipping Company
Ch Mate 08/10/2008.
13/04/2009.
CONTAINER – W/W
MSC VERONIQUE Panama
32341 Container1800 TEU
40200 Mediterranean Shipping Company
Ch Mate 17/10/2007.
16/04/2008.
CONTAINER – W/W
MSC STEFANIA Panama
23881 Container1500 TEU
32200 Mediterranean Shipping Company
Ch Mate 08/10/2006.
15/04/2007.
CONTAINER – W/W
ANY ADDITIONNAL INFORMATIONS OR JOB DESCRIPTIONS /EXPERIENCES YOU WANT TO DETAIL IN PARTICULAR. WRITE HERE:Detail the work you have done onboard previous vessels and your previous experience
Application Form Page 3 of 3