EMPLOYMENT APPLICATION FORM

Position applied for: Legal Data Entry Specialist

____________________________________
APPLICANT’S INFORMATION
1st Name 2nd Name 1st Last Name 2nd Last Name
RAMON JAVIER SALDIAS JIMENEZ

ID # Social Security # Home Phone # Cell Phone #

8-891-1285 8-891-1285 N/A 50764003737

Address
District Neighborhood Street House / Building Apartment
SAN FRANCISCO VIA PORRAS 68 #22 #22

E-mail:

I have problems with the following shifts: I am ready to start working by?
8 am to 5 pm 9 am to 6 pm I'M READY FOR BUSINESS RELATIONS. I HAVE
10:30 am to 7 pm 11:30 am to 8 pm AVAILABILITY FROM NOW ON.
12:30 md to 9 pm
I know the following LOGS’ current employees:
Full Names Relationship

JEAN PETER WIFE'S EX-COLLEAGUE

I do hereby acknowledge that I am legally authorized to work in the Republic of Panama, that all the
information I have provided on this form and other documents I have presented is true. I also authorize
LOGS of Panama, S.A. to verify my job references at its convenience.

RAMON J. SALDIAS 3/5/2021

Applicants’ signature Application Date

EMERGENCY INFORMATION
My blood type I’m allergic to: Medical conditions to be aware of in case of emergency

O+ N/A N/A
Person to be called in case of emergency:
Full Name Home Phone # Cell Phone # Address
Yosslay L. Quijano N/A 6351-2980 LAS ACACIAS CALLE D

TO BE COMPLETED BY THE HR DEPARTMENT AT HIRING

Position: Department / Team Starting Salary: Starting Date: Authorized by

Gender Marital Status Birth Month Day Year Age

Male Female Single Married Free union Divorced date