(1) DATA OF EMPLOYEE
REFERENCE Nº
Last name:                                            First name:
Address :                                                           City:
State:                               Zip code:                      Country:
Telephone:                                       Fax:
Position:                                          Marital Status:
(M).………..(D)………...(S)…..…...…..
(2) I WANT TO BE PAID BY: a / BANK TRANSFER             b/ CASH  c/Cheque
                                                   Sex: …………Age……………
(3) NEXT OF KIN
First Name:                           Last Name:
Occupation:                           Telephone nº:                         Fax nº
Address:
City/State:                           Country:                              Zip:
(4) DECLARATION
I (MR/MRS)………………………………………………………………………… HEREBY DECLARE THAT I HAVE NEVER BEEN
PROSECUTED OR JAILED FOR ANY CRIMINAL ACT BY ANY COURT OF LAW AND THE
INFORMATION THEREIN IS SOLELY FOR MY EMPLOYMENT WITH THE DELTA MARINE
(UK)LIMITED.
                                                      Signature:
Date:
Delta Marine (UK) Ltd. 2.Mounthooly Street, Lerwick, Shetland,Scotland. ZE1 0BJ United Kingdom