WORK PERMIT QUESTIONNAIRE

1. PERSONAL INFORMATION (please fill in with no abbreviations)

Full name

Nerwin Aramis Rubio Gonzalez

Gender

Date of Birth

Day/month/ year

21-sebtiempre -1973

masculino
Place of Birth

City

State

Maracaibo

Country

Zulia

Venezuela

Nationality

Venezolano
2nd Nationality
Current home address

B. Carmelo urdameta A.V 103 Casa 70-55

Phone number

Email

+584246213747
Marital Status

Single
X

Married

narg@hotmail.com
Divorced

Widower

Common Law

Other (specify):

Profession

Mecanico
Passport number

112091136
Fathers complete
name**
Nationality

Antonio Aramis Rubio Gonzalez

Venezolano

Mothers complete
name**
Nationality

Maria Lourdes Gonzalez

Venesolana

*According to the name printed on your passport;

**According to the name printed on the birth certificate
2. SALARY - Please inform your last monthly gross salary received in your local
currency:
Last monthly gross salary

16100 BsF

3. START DATE
Please inform the estimated
start date in Brazil

06-Julio 2015

4. CONSULATE
After the approval of the work permit, the visa will be sent to the Brazilian Consulate in the jurisdiction of
your residence, where you have been living for the latest 12 months, OR in the country of your nationality.
Be aware that it is not possible to change Consulate after the visa application has been filed. Please

inform below to which Brazilian Consulate the visa should be sent to:
City:

Country:
Maracaibo

Venezuela

5. ADDITIONAL INFORMATION
Please inform if you have previously held a resident / work visa in Brazil (temporary or permanent), other
than Business or tourist visas. If that is the case, please inform the following:
Period of stay
Type of Visa
Nr of RNE
Nr of CPF

6. EDUCATION
ELEMENTARY SCHOOL
Schools full name
U.E Estatal 1ro de mayo
Location

City

Country

Venezuela

Maracaibo
Period of study

From

To

1986

1982

HIGH SCHOOL
Schools full name
U.E JOSE ANTONIO ALMARZA
Location

City

Country

Venezuela

Maracaibo
Period of study

From

To

1992

1986
Course / Degree
Bachiller en ciencia

TECHNICAL
Schools full name
Location

City

Country

Period of study

From

To

Course / Degree

UNIVERSITY
1

Schools full name

Location

City

Country

Period of study

From

To

Location

City

Country

Period of study

From

To

Course / Degree

2
Schools full name

Course / Degree

POSTGRADUATE / MASTERS / DOCTORS

1
Schools full name
Location

City

Country

Period of study

From

To

Location

City

Country

Period of study

From

To

Course / Degree

2
Schools full name

Course / Degree

7. PROFESSIONAL EXPERIENCE
Please detail your last years of professional experience relevant to your responsibility and activities to be
performed in Brazil.
COMPANY 1

Companys full
name

COLECTIVO CORAZON DE JESUS C.A

Location

City

Maracaibo
Period

Fro
m

Count
ry

Venezuela

To

1991

1996

Position
Jefe de patio
Detailed
activities
performed

Tena a cargo toda el rea de mantenimiento, compra, mantencin de las

unidades
Transporte pblico, y garantizar el funcionamiento de las unidades,
ejecutar los planes de mantenimiento, organizar los turnos de trabajo,
velar por los inventarios de los repuestos
Participar en las reuniones de los planes de mantenimientos semanales y
mensuales

COMPANY 2
Companys full
name

TRANSPORTE EL LABERINTO C.A

Location

City

Maracaibo
Period

Fro
m

Count
ry

Venezuela

To

1997

2002

Position
Mecnico de primera
Detailed
activities
performed

Reparaciones de motores, transmisiones, sistemas hidrulicos, Sistema de

aires, plantas y bomba y reparaciones generales de unidades pesadas
Manejos de herramientas mecnicas, manejos de equipos de corte,
conduccin de carga pesadas
Ejecutar los planes de mantenimiento, cumplir con los entrenamientos de
la porte tcnica y de seguridad

COMPANY 3
Companys full
name

TRANSPORTE EL LABERINTO

Location

City

Maracaibo
Period

Fro
m

Count
ry

Venezuela

To

2003

2008

Position
Jefe de taller
Detailed
activities
performed

Tena a cargo toda el rea de mantenimiento, supervisin de operadores,

mantenimiento preventivo de las unidades, compra de repuesto e
inventarios de almacenes
Realizar planes de mantenimiento preventivo y corretivo,velar por
inventario de respuesto, garantizar el funcionamiento de todos los equipo,

implementar mejoras en el rea de trabajo, organizar planes de

entrenamiento para los mecnico

COMPANY 4
Companys full
name

ORICA VENEZUELA C.A

Location

City

Maracaibo
Period

Fro
m

Count
ry

Venezuela

To

2009

2015

Position
Mecanico de primera
Detailed
activities
performed

De motores disel, sistemas hidrulicos, transmisiones, sistemas de aires,

bomba, compresores velar por los inventarios de los almacenes,
mantenimientos de las unidades, cumplir con todo el entrenamiento
tcnico de seguridad y procedimiento

I declare, under the penalties of the law, particularly under the sole paragraph, Item A, of Article 65
of Law nr. 6815 of August 19, 1980, that all the information provided in this curriculum vitae is true
and undertake to provide documentary evidence of such information, if required.
Place and date:
Signature: