APPLICATION FOR EMPLOYMENT

OBO Major Rehabilitation Project

Montevideo, Uruguay
I. GENERAL INFORMATION
COMPANY/ POSITION APPLYING FOR ATTACH PHOTO TAKEN WITHIN PAST 12
DATE OF APPLICATION MONTHS AT UPPER RIGHT CORNER
JMV Ingénierons sas. Technical
21-february-2020
electrician.
OTHER NAMES USED
FULL NAME OF APPLICANT
(Last Name) (First Name) (Middle Name)
Lesmes Daza Luis Carlos
CURRENT ADDRESS TELEPHONE NUMBER
Route 9a #12-30 Aguazul Casanare. +57 3204487692

DATE OF BIRTH (m/d/y) PLACE OF BIRTH (City, Country) SEX

09-october-1989. Aguazul Casanare Colombia. Female x Male
CITIZENSHIP AT BIRT PRESENT CITIZENSHIP HEIGHT WEIGHT
Colombian. Colombian. 1.70 74 kg

II. PASSPORT DATA

COUNTRY PASSPORT ISSUED PASSPORT NUMBER DATE ISSUED
Colombian AU862422. 06-june-2018.
III. NATIONAL IDENTITY CARD
NATIONAL IDENTITY CARD NUMBER COUNTRY ISSUED DATE OF EXPIRATION

1116545400 Colombian 27-november-2007.

IV. PREVIOUS RESIDENCES (for past five years)
Date Street Address: route 7d #185-10 usaquen City/Country
(From) june-2017 (To)January-2018 Phone Number: +57 3208358232 Bogota DC.
Date Street Address: rote 4#31-10 City/Country
(From) December-2015 (To) may-2016 Phone Number +57 3152123409 Puerto Boyacá –Boyacá.
Date Street Address: route 16a #23-2. City/Country
(From)Septenber-2018 (To)February-2019 Phone Number: +57 3015491315. Valledupar-Cesar
V. FAMILY
CURRENT MARITAL STATUS: check one box
x Never Married Married Separated Legally Separated Divorced Widowed
FULL NAME OF CURRENT SPOUSE DATE OF BIRTH PLACE OF BIRTH PRESENT ADDRESS

FULL NAME OF APPLICANT’S FATHER DATE OF BIRTH PLACE OF BIRTH PRESENT ADDRESS
Aguazul Casanare
Luis Rubilson Lesmes Cardenas 15-october-1961. Colombia. Route 9a #12-30.

FULL NAME OF APPLICANT’S MOTHER DATE OF BIRTH PLACE OF BIRTH PRESENT ADDRESS

Ana leyda Daza Espinosa. 20-february-1968 Orocue Casanare Route 9a #12-30.

Colombia.
VI. MILITARY SERVICE
COUNTRY DATES PURPOSE

Revised 07/1/2010 Page 1 of 3

 APPLICATION FOR EMPLOYMENT
OBO Major Rehabilitation Project
Montevideo, Uruguay

VII. EDUCATION
NAME AND LOCATION OF EDUCATIONAL DATES DEGREE MAJOR SUBJECTS
INSTITUTIONS ATTENDED FROM TO
Jorge Eliecer Gaitan School 1998 2008 Secondary school
graduate
Sena casanare. 2009 2010 Technical electrician. Electrical construction and
assembly.
VIII. WORK EXPERIENCE (last two employments, most recent employer first)

EMPLOYER
(Name) massy energy Colombia sa. (Address) route 45a #93-64 Bogota dc.

DATES OF EMPLOYMENT EXACT TITLE OF YOUR POSITION

(Start Date) 13-june-2019 (End Date) 31-october-2019 Electrician first commission.

IMMEDIATE SUPERVISOR
(Name) Edgar Rodriguez (Title) engineer.

REASON FOR LEAVING :

Contract term.
EMPLOYER
(Name) hmv ingenieros sa. (Address) route 43a#11a-80 Medellin Colombia.

DATES OF EMPLOYMENT EXACT TITLE OF YOUR POSITION

(Start Date) 24-september-2018 (End Date) 16-june-2019. Electrical officer.

IMMEDIATE SUPERVISOR
(Name) Mario Geney (Title) engineer

REASON FOR LEAVING

Voluntary retirement.
IX. EMPLOYMENT RECORD
If you have ever been fired, quit, or left a job under unfavorable circumstances, provide the month and year, specific reason for
leaving the job, and your former employer’s name and address below.

X. POLICE RECORD/PERSONAL CONDUCT Yes No

If yes, provide explanation
A. Have you ever been arrested or detained by any police or military authority? x
B. Receipt of Certificado de Antecedents Judicial attached? x

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 APPLICATION FOR EMPLOYMENT
OBO Major Rehabilitation Project
Montevideo, Uruguay

XI. TRAVEL
DATES
COUNTRY PURPOSE
FROM TO
Quito Ecuador 02-july-2016 O5-july-2016 Tourist.
Barcelona Venezuela. 25-november-2019 18-december-2019 Interventoria sulfer pastilladora refinery.
Independent.

XII. APPLICANT CERTIFICATION

I certify that, to the best of my knowledge and belief, all of the information on and attached to this application is true, correct,
complete and made in good faith. I understand that false or fraudulent information on or attached to this application may be
grounds for not hiring me or for termination after I begin work. I understand that any information I give may be investigated.

_____________________________________________
APPLICANT PRINTED NAME

_____________________________________________ __________________
APPLICANT SIGNATURE Date

Revised 07/1/2010 Page 3 of 3