Affix Passport

2 Marsham Street
London SW1P 4DF
England.

ENGLAND EMPLOYMENT PERMIT FORM

ERF/678AA/Ref No.....

NAME: PLESOIANU HARICLEIA

ADDRESS : 1, Victory Street Ploiesti, block 1 ap 20 Victory street
DATE OF BIRTH 10.10.1981
SEX: FEMALE
MARITAL STATUS: SINGLE
PASSPORT No.: NO PASSPORT (CITIZEN OF European Union)
NATIONALITY : ROMANIAN
PURPOSE OF VISIT: WORKING
EMPLOYER: BRITISH ENGLISH INSTITUTES
EMPLOYER ADDRESS: 158, Long Acre, London WC2E 9JL England
TEL:00447024027662 FAX:0044847743109
Are you travel alone NO? YES? If no give particulars of people
traveling with you.
NAME:
PASSPORT No.:
NAME:
PASSPORT No.:
NAME:
PASSPORT No.:
DECLARATION

I ............................PLESOIANU HARICLEIA.......................................... Undertake that

should any information given by me proven to be untrue, I may be liable to
prosecution or denial of employment permit.
Sign............................................................
Date...................23.11.2011.....................................

OFFICIAL USE ONLY

Application is recommended/ Not recommended

NameTOMA IRINA.
RankLECTOR DOCTOR .
Recommending OfficerSERSEA ANDREEA
Final ApprovalUNIVERSITY COMMITTEE OF UPG
PLOIESTI.

Signature & Date21.112011...