Address Line 1 (Blk No, Unit No.) Address Line 2 (Street/Bld Name) ity Address "ype P#one Num$er & 'ome (1) !c#ool) Postcode !ome "ddress Corresponden#e
( ountry ode - Area ode - P#one No% e . $%&'()''** or $(*&)*+)'%,)
!tate
ountry
Date (MM)....)
From
"o
Employer
Position 'eld
Lea+ing 0eason
!eagate
on1idential)re+ Aug 23
Pa e ( o/ 0
0e1erence
Please name 0 persons, ot4er t4an yo5r /amily mem2ers and relatives, 64o are in a position to eval5ate yo5r employment. Re/erees s4o5ld pre/era2ly 2e asso#iates /rom yo5r 6ork or a#ademi# #ir#le) Name ontact Num$er 4ccupation .ears 5no/n 0elations#ip
(. I am (+ years old and a2ove 0. !ave yo5 ever 2een #onvi#ted or pendin trial in a #o5rt o/ la68 I/ yes, 64en3 99999999999999999999 :ype o/ ;//en#e3 999999999999999999999999999
7es 7es
No No
,. "re yo5 servin any s#4olars4ip / st5dy loan 6it4 anyone / or ani<ation8 %. "re yo5 servin any 2ond 6it4 yo5r present employer8 4t#er In1ormation ). !ave yo5 #ompleted National Servi#e8 '. -o yo5 4ave any relative(s) 6it4 t4is #ompany8 I/ yes, please state N.".
No No No No
6eri1ication $y '0 !ta11ing& 99999999999999999999999999999999999999999999999999999999999999999999999 *. =ere yo5 ever employed 2y any Sea ate :e#4nolo y In#orporated "//iliate8 I/ yes, please state Plant3 99999999999999999 Position3 999999999999999999 7es No
Period3 99999999999999999
+. !o6 did yo5 #ome to kno6 a2o5t t4is >o2 va#an#y8 Ne6spaper Internet Sea ate /riends Sea ate 6e2site ?mployment " en#y, please spe#i/y3 99999999999999999999999 ;t4ers, please spe#i/y3 9999999999999999999999999999999999
Agreement)Declaration
I #erti/y t4at all in/ormation s5pplied 2y me in t4is appli#ation and res5me are #omplete, tr5e and a##5rate. I 4ere2y a5t4ori<e Sea ate :e#4nolo y International or its a ents to investi ate and to veri/y t4e in/ormation #ontained in t4is appli#ation and/or t4e res5me. I 4ere2y 6aive all or any lia2ility in #onne#tion 6it4 Sea ate :e#4nolo y International or its a entsB investi ation and veri/i#ation o/ t4e said in/ormation in#l5din lia2ility /or dis#los5re to t4ird parties. I 5nderstand t4at any /alsi/i#ation, misstatements or omission o/ any in/ormation in #onne#tion 6it4 t4is appli#ation may disC5ali/y me /rom 2ein #onsidered /or employment, or res5lt in termination o/ employment or s5#4 dis#iplinary a#tion as Sea ate :e#4nolo y International may deem appropriate.
__________________________ Si nat5re
__________________________ -ate