Contractor Application

Edison Chouest Offshore Companies

16201 East Main
Cut Off, LA 70345

In order to be hired, you must be willing to submit to a physical and urinalysis screening. YES □ NO □
Today’s Date: ___________________________
AUGUST 24, 2023

Personal Information:
Last Name: First Name:
E Q U I N A S E A N B E N E D I C T

Middle Name(s):
P A M A T I - A N

Position interested In: ___________________________

DECKHAND
Have you worked here before? YES □ NO □
Nationality: _____________________
FILIPINO ______ Visa / Work Status: _____________ _____________
Mailing Address: OCHANDO, NEW WASHINGTON, AKLAN
City, State/Province and Postal Zip: AKLAN, 5610
Legal Residence: OCHANDO, NEW WASHNGTON, AKLAN
E-Mail Address: seanbenedictequina23@gmail.com
Social Security # (If Applicable): 07-4112393-2
Cell Phone: ( +63 ) 9_ 1_ _
6 - 2_ 9_ 1_ 0_ 6 6 9

In case of emergency, notify: MARSHA P. EQUINA Relation: MOTHER

Phone: 09453609550 E-Mail: m.equina@yahoo.com

Employment Reference: (Please Provide 2 recent employment reference and attach a CV providing work
history for the past 5 years)
May we contact your current employer? YES □ NO □
REFERENCE: EMPLOYMENT DATES: FROM TO
Title Ending Salary
What kind of work did you do?
REFERENCE: EMPLOYMENT DATES: FROM TO
Title Ending Salary
What kind of work did you do?
Criminal Background Information
Have you ever been convicted of a crime other than a minor traffic offense? Yes □ No □
(Answering yes will not disqualify you from further consideration, but a false answer will.)
Date Nature of Conviction City, State, Country Outcome

1/12/18-llr 1