| DATE OF ENTRY |
2010-4-16 |
|
| CALL YOUR FAVORITE JOB N° I |
HEAVY DUTY WELDIND |
|
| CALL YOUR FAVORITE JOB N° II |
MECHANIC |
|
| FAMILY NAME |
MUSSENDIJK |
|
| FIRST NAME |
EVERALDO |
|
| FURTHER NAMES |
ROBESPIERRE.E |
|
| DATE OF BIRTH |
1973-5-11 |
|
| PLACE OF BIRTH |
MOENGO-SURINAME |
|
| NATIONALITY |
SURINAME |
|
| RELIGION |
CHRISTIAN |
|
| MARITAL STATUS |
SINGLE |
|
| HOME ADDRESS / STREET & N° |
NEW CHARLES BURG #25 |
|
| POSTAL CODE (ZIP) |
597 |
|
| CITY |
PARAMARIBO |
|
| COUNTRY |
SURINAME |
|
| NEXT AIRPORT |
JOHAN ADOLF PEGEL AIRPORT |
|
| YOUR MOBILE N° |
contact mycruiseship.info |
|
| YOUR REGULAR PHONE N° |
contact mycruiseship.info |
|
| YOUR E-MAIL |
contact mycruiseship.info |
|
| YOUR ENGLISH LANGUAGE |
perfect |
|
| YOUR FRENCH LANGUAGE |
poor |
|
| YOUR GERMAN LANGUAGE |
motherlanguage |
|
| OTHER LANGUAGES |
dutch,portaguese |
|
| FORMER EMPLOYMENTS - COMPANIES |
SHELL COMPANY OF BERMUDA LTD |
|
| FORMER EMPLOYMENTS - COMPANIES |
bhpbilliton suriname |
|
| PASSPORT EXPIRE DATE |
15 sept 2010 |
|
| VALID SEAMANS BOOK |
no |
|
| NATIONAL LICENSE FOR SEAMAN |
no |
|
| GMDSS NAT. DOC. FOR SEAMAN |
no |
|
| I confirm all the above data are correct |
Yes |
|
| I confirm the right of Wave-Conn to publish my above insert personally data |
Yes |
