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APPLICATION FORM Position Applied H2S Engineer Personal Information Name as in NRIC or Passport BENNY VARGHESE NRIC / Passport No. H7020264 Nationality INDIAN Place of Birth KERALA Date of Birth & Age (dd/mm/yyyy) 30/10/1987 Marital Status SINGLE No. of Children & Ages NA Address: KALLINGAL HOUSE,KAYARADI P.O,PALAKKAD, KERALA,INDIA-678510 Home / Office Tel: 00919496352385 Mobile: 009199618961801 Language Proficiency Spoken & Written ENGLISH , HINDI , MALAYALAM Spoken Only TAMIL Academic Qualifications (in chronological order, starting with the most recent) Date From To Schools/Institutions Attended Qualifications Obtained (Masters, Degree, Diploma, ‘A’/’O’ Levels) Field of Study / Major 2005 2009 Mahatma Gandhi University B.Tech Electronics & Instrumentation Enginnering Other Qualifications / Courses / Membership Attained (in chronological order, starting with the most recent) Date From To Qualifications Obtained Date 2009 july 2009 august Undergone training on DCS ( Centum CS 3000 R3 Engineering and Maintenance) conducted by Yokogawa India Ltd. Undergone training on PLC (Prosafe by Yokogawa) conducted by Yokogawa India Ltd. Undergone training on Field bus technology conducted by Yokogawa India Ltd.

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Page 1: Application

APPLICATION FORM

Position Applied H2S Engineer

Personal Information

Name as in NRIC or Passport

BENNY VARGHESE

NRIC / Passport No. H7020264

Nationality INDIAN

Place of Birth KERALA

Date of Birth & Age(dd/mm/yyyy)

30/10/1987

Marital Status SINGLE

No. of Children & Ages NA

Address: KALLINGAL HOUSE,KAYARADI P.O,PALAKKAD,KERALA,INDIA-678510

Home / Office Tel: 00919496352385 Mobile: 009199618961801

Language Proficiency Spoken & Written ENGLISH , HINDI , MALAYALAM

Spoken Only TAMIL

Academic Qualifications (in chronological order, starting with the most recent)

Date

From ToSchools/Institutions Attended Qualifications Obtained (Masters,

Degree, Diploma, ‘A’/’O’ Levels)Field of Study / Major

2005 2009 Mahatma Gandhi University

B.Tech Electronics & Instrumentation Enginnering

Other Qualifications / Courses / Membership Attained (in chronological order, starting with the most recent)

Date

From ToQualifications Obtained Date

2009 july

2009august • Undergone training on DCS ( Centum CS 3000 R3

Engineering and Maintenance) conducted by Yokogawa India Ltd.

• Undergone training on PLC (Prosafe by Yokogawa) conducted by Yokogawa India Ltd.

• Undergone training on Field bus technology conducted by Yokogawa India Ltd.

Page 2: Application

APPLICATION FORM

Employment History (in chronological order, starting with the most recent)

Date

From To

Firm/Institution Position Held Reason(s) for Leaving

Total number of years spent in oil/gas/petrochemical industry: 1.5 years

Details of Current Employment

Present Employer ConSyst Integrated Control Systems, Cochin

Designation Application Engineer

Started Date Notice Period(weeks / months)

1 month

Present Monthly Salary 600 $ Expected Monthly Salary 1300 $

Other Information

Have you been suffering from any physical impairment or disease? No

Have you ever been discharged or dismissed from the services of a previous employer? No

Have you ever been convicted in a Court of Law in any country ? No

If the answer is “yes”, give details. ________________________________________________________________________________

____________________________________________________________________________________________________________

Referees

Page 3: Application

APPLICATION FORM

Please give details of two referees whom Rutledge E&P may approach for references.

1. 2.

Jasir Sabri

Chief Executive

Mob. +(91)-9387885015 Email – [email protected] Integrated Control Systems CeeYem Building | Company Padi |Kerala | India |683 106 |

Declaration

I declare that the information given above is, to the best of my belief, true and correct and that I have not suppressed any fact. I understand that any misrepresentation or omission of any fact will be sufficient cause for the cancellation of consideration for employment or dismissal from Rutledge E&P’s or its affiliate’s service if I have been employed.

Signature of applicant: benny varghese Date: 09/02/2011