CREW APPLICATION FORM 6 Crew le,atIon41 Specializing In the Placement of Professional, Qualified Crew for the Luxury Mega Yacht Industry Be a Part of the Team, the "Best of the Best" Position: In Yachting Since: Today's Date: Start Date: Name: Salary: Negotiable: VD ND Current Local Contact Address: Street/Crew House City: State: Zip: Country: Cell Phone: WhatsApp Phone Number: Skype: E-mail: Emergency Contact Information: Name/Relationship: Street: City & State: Country: E-mail: Cell Phone: Phone: Personal Data Nationality: US Green Card: Y K N Drivers License #: Country: Passport #: Expiry Date: US Travel Visa: Expiry Date: Height: Weight: Date of Birth: ELITE Uniform Size (US): Shirts: Pants: Shoes: Will Place Do you Smoke? Y O N o Occasionally O Daily O Your Do you Drink? Y O N O Occasionally O Daily O Photo Here Any Medical Conditions? YO NO If yes, Explain: Dietary Requirements: Do you have tattoos that will be visible in uniform? YO NO If yes, explain location & size Languages Spoken: Computer Literacy: Beginner O Intermediated Advanced O 112 Rose Drive Fort Lauderdale, Florida, 33316 USA Drug Test: Will Take: YE NE Date Taken: Ever Convicted/Arrested: Y K NE Reason: One Ocean, Marina Port Vell Carrer Escar, 26, Barcelona, Spain Agree to Background Check: YE NE Date Completed: 08039 Hobbies: Last book you read: FLL Ph: Dive Certified: YE NE Level: BCN Ph: STCW-95 Certified: YE NE Highest License: Valid ENG-1 Medical: YO N O Expiry Date: Additional Licenses: Website: www.elitecrewintl.com In accordance with MLC 2006, I verify that the above information is correct. EFTA_R1_00020253 EFTA01736085