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Mexicrew Maritime Services S.A.

AP P L IC AT I ON FOR EM P L OY ME N T
U SI N G LE G I BLE P RI N T , P LE A SE C O MP LE TE T H I S F O RM I N I T S E N T I RE T Y

1. Personal Information
Last Name: Solano
First Name: Gabriel Middle Name(s): Antonio
Date of Birth (mm/dd/yyyy): 9/11/1986 Birth Place (city): Caracas
Country of Birth: Venezuela Nationality: Venezuelan
Gender: Male Female Hair Color: Brown
90 172
Weight: lbs. or kgs. Height: feet inches or cm
Do you have Tattoos? No Yes
Are the tattoos visible when wearing short-sleeved shirts, shorts or skirts? No Yes
2. Contact Information
Permanent Address
Street 1: 4 Street 2:
City: Caracas State/Province: Distrito Capitam
Zip/Postal Code: 1070 Country: Venezuela
Phone Numbers (include country codes and area codes) and E-mail
Home Phone: 02122575010 Mobile Phone: +584129088221
E-mail Address: gabrielsolanfoto@gmail.com Closest Intl Airport: Maiquetía
3. Dependant Information
Marital Status: Single Married Divorced Widowed Other
Number of children under 18 years of age? 1
Emergency Contact Information
In the event of an emergency, I would like the company to contact the following person or persons:
Person 1 Relationship: wife
Last Name: Carrillo
First Name: Lady Middle Name(s): Carol
Home Phone: 02122674680 Mobile Phone: +584126187438
E-mail Address: lccr141@gmail.com
Person 2 Relationship: Mother
Last Name: Avila
First Name: Delvalle Middle Name(s):
Home Phone: 02122575010 Mobile Phone:
E-mail Address: La California, Caracas