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APPLICATION FORM FOR EMPLOYMENT Attach

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Personal Information
Name
Luis Manuel

Address City State Zip


Los Alamos Mz:A Lt:13 Nuevo Chimbote Peruvian 02710

Phone Number Mobile Number Email Address


- +51 920396793 manueluc16@gmail.com

Are You A U.S. Citizen? Have You Ever Been Convicted Of A Felony?
Yes No X Yes No X

If Selected For Employment Are You Willing To Submit to a Pre-Employment Drug Screening Test?
Yes X No

Position
Position You Are Applying For Available Start Date Desired Pay
Post of Mechanical Engineer immediately 9000 GBP

Employment Desired
X Full Time Part Time Seasonal/Temporary

Education
School Name Location Years Attended Degree Received Major
Bachelor in Mechanical
National University of Santa Chimbote 5
Engineering

References
Name Title Company Phone
Ing. Christian Sastre Novoa mechanical engineer Siderperu - GERDAU +51 959370877

Carlos Ferrer project engineering consultant Siderperu - GERDAU +56 984093510


Employment History
Employer (1) Job Title Dates Employed
SIDERPERU PROFESSIONAL PRACTITIONER

Work Phone Starting Pay Rate Ending Pay Rate

Address City State Zip


Av. Santiago Antúnez de Mayolo, s/n Chimbote Peruvian 02800

Employer (2) Job Title Dates Employed


TANKS AND TAPAS S.A.C. ASSISTANT QUALITY CONTROL

Work Phone Starting Pay Rate Ending Pay Rate

Address City State Zip


CAR.PANAMERICANA SUR KM. 19.8 Lima Peruvian 15800

Employer (3) Job Title Dates Employed


COMET S.R.L. PROJECT CADISTA

Work Phone Starting Pay Rate Ending Pay Rate

Address City State Zip


Urb. Los Álamos, Av Brasil 6515 Nuevo Chimbote Peruvian 02710

Employer (4) Job Title Dates Employed

Work Phone Starting Pay Rate Ending Pay Rate

Address City State Zip

Employer (5) Job Title Dates Employed

Work Phone Starting Pay Rate Ending Pay Rate

Address City State Zip

Signature Disclaimer
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may
result in my release.

Name (Please Print) Signature


Luis Manuel Urbina Carrasco

Date
07/09/18

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