Language Proficiency (Leave blank if not applicable)
Enter appropriate number from code below to indicate level of your language proficiency.
1. Limited conversion, reading of newspapers, routine correspondence.
2. Engage freely in discussions, read and write more difficult material.
3. Speak, Read and write.
Language
Speak
Read
Write
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{{e.speak}}
{{e.read}}
{{e.write}}
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Society/Affiliation
Membership No
Date
Remarks
{{e.society}}
{{e.no}}
{{e.mdate}}
{{e.remarks}}
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Three references required.
Name
Organization & Position
Address
Telephone
Email
{{e.rname}}
{{e.org}}
{{e.raddress}}
{{e.rtelephone}}
{{e.remail}}
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HAVE YOU EVER BEEN ARRESTED, INDICTED, OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING, OR CONVICTED, FINED, OR IMPRISONED FOR THE VIOLATION OF ANY LAW (EXCLUDING MINOR TRAFFIC VIOLATIONS)?
Please provide reason:
I certify that the statement made by me in answer to the foregoing questions are true, complete and correct to the best of my knowledge and belief. I understand that any misrepresentation or material omission made on a Mari Petroleum Company Limited Personal History form or other document requested by the Organization renders a staff member of the Mari Petroleum Company Limited liable to termination or dismissal.
Note: You may be requested to provide documentary evidence of the statements you have made above. Do not, however, send any documentary evidence until you have been asked to do so and, in any event, do not submit the originals of any references, testimonials or certificates of academic achievement unless they have obtained for the sole use of Mari Petroleum Company Limited.