NOLAN FREELANCE INFORMATION SHEET

The Audio Vdao Soluion

Legal Name:
Raven spears Nickname:

Street Address: 5112 mercy seat rd Apt #/ Bidg #:

City:
Hazlehurst State: Ms Zip:
39083
Home Phone:

Personal Cellular Phone: (769)253-4161

Personal Emil Address (Please Print Clearly): rVnspears@outlook.com
Date of Birth: 01/15/1993
Would you drive a company vehicle? YES NO If yes, please complete license information below:

Driver's License Number and Issuing State:

Any Endorsements on License (Class A, Class B, Motorcycle, etc.):

Do you smoke? ? YES NO Do you have any tattoos (visible under short sleeve shirt)? YES NO

What is your shirt size for a T-shirt?IO For a formal shirt (i.e. neck and sleeve length)?
m
Have you ever been charged or convicted of a crime? YES NO if yes, please explain,

possession of cannabis

SKILLS, TRAINING

Please list the specific skills and/ortraining that you offer:

rigger lual/fork/manlift certified operator

up to 12k

EMERGENCY CONTACT INFORMATION

Name:
Edna Danielle Webster

Relationship: domestic partner

Daytime Telephone:.

Evening Telephone:

Cellular /Mobile/ Pager:

(601)748-2665

EMPLOYMENT STATUs

Freelance Office Use: Updated