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Candidate Submission form Date: Name: Skype address: Date of birth: Height: Weight: Position Applied for: Expected

day rate in USD: Available? Nationality: Total years of Industry experience:

Date from

Date to

Position held

Type of Rig

On or Offshore

Cyber based? Y/N

Company

Reason for leaving

Denis Clifton Email: denis@robionselection.com

Interviewing of this candidate constitutes acceptance of RSC Selections Terms of Business.

Tel: +66 (0) 843622110

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