APPLICATION FOR EMPLOYMENT

AN AFFIRMATIVE ACTION AND EQUAL OPPORTUNITY EMPLOYER

TO BE COMPLETED BY EMPLOYMENT OFFICE:
RECRUITER_______________________________
DATE RECEIVED___________________________
PLEASE COMPLETE ALL SECTIONS, SIGN, AND DATE THE APPLICATION.
GENERAL INFORMATION
NAME Javier Colina SOCIAL SECURITY NUMBER
ADDRESS Calle Oeste 12 N 31 J!"i#ana $al%on

&STREET' &CITY' &STATE' &(I) CODE'
*OME )*ONE NUMBER &+,-' 2./20.110 BUSINESS )*ONE NUMBER &+,-'020.2,3-,1
ALTERNATE CONTACT2
*A3E YOU E3ER *AD A SECURITY CLEARANCE4
YES
NO
5*AT LE3EL4 5*EN ISSUED4
I$ YOU ARE UNDER 1-
YEARS O$ A6E7 DO YOU
*A3E A 5OR8 )ERMIT4
YES
NO
*A3E YOU E3ER
BEEN CON3ICTED
O$ A $ELONY4
YES
NO
I$ O$$ERED EM)LOYMENT7 CAN YOU S*O5 )ROO$ O$ U9S9
CITI(ENS*I)7 OR I$ A NON:CITI(EN7 )ROO$ T*AT YOU ARE
LE6ALLY ENTITLED TO 5OR8 IN T*E U9S94
YES
NO
IN THE PAST TWO YEARS, HAVE YOU BEEN A "PROCUREMENT OFFICIAL" IN RELATION TO A U.S. GOVERNMENT CONTRACT FOR WHICH
WORLEYPARSONS WAS A PRIME CONTRACTOR OR SUBCONTRACTOR? YES NO
JOB INTEREST
TY)E O$ 5OR8 OR
)OSITION DESIRED
Co;;isionin<
5*EN COULD
YOU START4
O%t!#er7 2110
MONT*LY BASE
SALARY DESIRED
12111 =
TY)E O$ EM)LOYMENT
DESIRED2
&C>e%? a@@ro@riate %ate<ories'
$ULL TIME
)ART TIME
RE6
TEM)
US
$OREI6N:SIN6LE STATUS
$OREI6N:$AMILY STATUS
S*I$T DESIRED
&I$ A))LICABLE'
1
st
2
n"
3r"
*A3E YOU E3ER
COM)LETED A
5orleA)arsons
A))LICATION4
YES
NO
*A3E YOU E3ER 5OR8ED $OR 5ORLEY)ARSONS YES NO
I$ YES7 )LEASE COM)LETE T*E $OLLO5IN62
COM)ANYB LOCATION
$ROM TO
)OSITION SU)ER3ISOR
5>ere "i" Ao! >ear a#o!t t>e @osition4
A"vertise;ent Co;@anA 5e#site E;@loAee ReCerral9 5>o4
E;@loA;ent A<en%A9 5>i%>4 MonsterDCareer#!il"er&Cir%le'
Jo# $air : E>i%> one4
Colle<e Ca;@!s IntervieE :5>ere4
Ot>er9
LIST ANY RELATI3ES EM)LOYED BY 5ORLEY)ARSONS

LIST ANY O$$ICE EFUI)MENT7 COM)UTER *ARD5ARE AND
SO$T5ARE )AC8A6ES OR CAD EFUI)MENT 5*IC* YOU *A3E
EG)ERIENCE O)ERATIN69

A))LICANTS $OR CLERICAL )OSITIONS ONLY
TY)IN6 S)EED S*ORT*AND
5)M
EDUCATION
NAME O$ SC*OOL AND LOCATION DATES
MAJOR COURSE O$ STUDY
DID YOU
6RADUATE
DE6REE
TY)E
$ROM TO
*I6* SC*OOL)re!nivertisatio )ara<!anH
Ba%>elor YES
NO
COLLE6E OR
UNI3ERSITY (!lia UniversitA
C>e;i%al En<ineerin< YES
NO
En<ineer
OT*ER EDUCATION
YES
NO

TEC*NICAL CERTI$ICATES7
LICENSES7 RE6ISTRATIONS7 ETC9
LIST MEMBERS*I)S IN ANY
)RO$ESSIONAL OR TEC*NICAL ASSOCIATIONS En<ineer Colle<!e 7 C>e;i%al En<ineer So%etA
U.S. MILITARY SERVICES
BRANC* O$ SER3ICE
RAN87 6RADE
OR RATIN6
YRS9DMOS
O$ SER3ICE
DESCRI)TION O$ DUTIES


EMPLOYMENT HISTORY
COM)LETE T*E $OLLO5IN67 LISTIN6 EM)LOYMENT DURIN6 T*E LAST 11 YEARS BE6INNIN6 5IT* MOST RECENT EM)LOYER9 INCLUDE ALL
)ERIODS O$ UNEM)LOYMENT AND ANY 3OLUNTEER ACTI3ITIES T*AT ARE JOB RELATED9
$ROM
11
MO9 12 YR 21119
TO 13
MO9 1/
YR9 2110
MOST RECENT )OSITION
Co;;isionin< an" Start U@ Mana<er
SALARY
,19111 Bs9
MAY 5E CONTACT4
YES NO
NAME O$ EM)LOYER
YI3 IN6ENEIRJA I CONSTRUCCIKN
TY)E O$ BUSINESS
E)C
SU)ER3ISORLS NAME
$ERNANDO *ERNANDE(
SU)ER3ISORLS TITLE
O)ERATIONS 3ICE )RESIDENT
ADDRESS
CARACAS
BUSINESS )*ONE

REASON $OR LEA3IN6
Loo?in< Cor neE C>allen<es9 )D3SA 5or? $or;er
6I3E DETAILS O$ RES)ONSIBILITIES7 DUTIES7 AND ACCOM)LIS*MENTS $ertiliMer )roNe%t O E)C: NeE )etro%>e;i%al Co;@leP &An%illarA $a%ilities
Area' O Consorti!; CC$M O YI3 : TOYO an" $errostaal
Co;;issionin< an" Start U@ Mana<erD$!n%tional Mana<er
Q Res@onsi#le oC )re%o;;issionin<7 Co;;issionin<7 Start !@ an" O@eration7 in%l!"in< trainin< "o%!;entation7 @!n%> list7 ;aintenan%e an"
eR!i@;ent ins@e%tion oC O@eratin< SAste;s2 Coolin< 5ater7 Sea 5ater7 )olis>e" Unit7 Desalination Unit7 Co;@resse" Air7 5aste 5ater )lant7 DSC
&E;erson'7 3 *i<> )ress!re Stea; Boilers &331 TonD>r'7 UtilitA S!#station &30,11 37 01.1 37 0-1 3 SEit%><ear7 MCCSs7 $ireI 6as Det%tion7 Servi%e an"
)ota#le 5ater7 Con"ensate7 Deareator7 C>e;i%al Dosa<e7 Li<>tin<7 Cat>o"i% )rote%tion7 Nitro<en an" !tilities inter%onne%tion Eit> A;;onia &1-11 TMD' I
Urea 2211 TMD' )lants9
)ro%ess2 DeCinition in%l!"es o@eratin< sAste;s7 #!siness @lannin<7 @re@aration oC "o%!;entation an" @ro%e"!res7 @ro"!%tion an" "evelo@;ent oC t>e MatriP
oC Control an" )!n%> List ;ana<e;ent7 "raCtin< %ontra%ts instr!;entation7 ele%tri%al an" ;e%>ani%al @arts an" s@are "eCinition oC CISU7 i;@le;entation oC
a%tivities oC )re:Co;;issionin<7 Co;;issionin<7 Start!@ I Testin< @ro@er C!n%tionin<7 "evelo@;ent oC SAT tests Eit> ven"ors7 Develo@;ent oC )roNe%t
Dossiers Closin< a;on< ot>ers9
Q Res@onsi#le Cor )re:%o;;issionin< an" Co;;issionin< Te%>ni%al Assistan%e oC NeE S!lC!ri% A%i" )lant &SA) III' in MorTn )etro%>e;i%al Co;@leP
Q Res@onsi#le Cor Te%>ni%al )ro@osal in )oEer 6eneration7 ReCinerA7 6as )lant7 )oEer )lants7 C>e;i%als )lants in CISU areas9
: )re%o;;issionin<7 Co;;issionin<7 Start !@ an" O@eration &CISU' servi%es7 in%l!"in< trainin< "o%!;entation7 @!n%> list7 ;aintenan%e an"
eR!i@;ent ins@e%tion Cor Co@a Ma%oAa 6as )lant EP@ansion &6as 6!Hri%o an" Tei?o?! oil Co7 LTD'9
: $!rrial Main Station
: )etro%e"eUo Main Station U@<ra"e
: Jose NeE )oEer 6eneration Station &31 M5' an" 1 Aear OIM $ast Tra%? )roNe%t
: 6!i%o NeE )oEer 6eneration Station &.1 M5' an" 2vAear OIM $ast Tra%? )roNe%t
Q )ersonnel A";inistration
Q S!# %onta%tor A";inistration
Q CISU $!n%tional A@@raisal
$ROM
1.
MO9 1 YR9 211.
TO 31
MO9 11
YR9 2111
MOST RECENT )OSITION

SALARY
1-9111 BS9
MAY 5E CONTACT4
YES NO
NAME O$ EM)LOYER JANTESA TY)E O$ BUSINESS E)C SU)ER3ISORLS NAME
ARNOLDO )ERE(
SU)ER3ISORLS TITLE
O)ERATIONS 3ICE )RESIDENT
ADDRESS CARACAS BUSINESS )*ONE REASON $OR LEA3IN6
6I3E DETAILS O$ RES)ONSIBILITIES7 DUTIES7 AND ACCOM)LIS*MENTS Consorti!; INCO3EN O Jantesa O SIEMENS
Q E)C )roNe%t Inter%onne%tion oC Central:EasternD5estern 6as Trans@ort SAste;s &ICO )roNe%t'
Q E)C )roNe%t Co;#ine" CA%le Cor 0,1 85 VTer;oM!lia IIW9
Q Res@onsi#le Cor Te%>ni%al )ro@osal in )oEer 6eneration7 ReCinerA7 6as )lant7 )oEer )lants7 C>e;i%als )lants in CISU areas9
: ANCA) ReCinerA U@<ra"e )roNe%t &Diesel *DS7 A;ine7 So!r 5ater an" S!lC!r )lant7 an" !tilities' : Ur!<!aA
: Los *!;eros II O NeE 6eot>er;al Station &2, M5' O MXPi%o
: Main Station U@<ra"e )roNe%t &MSU)' : )etroCe"eUo O 3eneM!ela
: Clean 6asoline )roNe%t O Antonio A;or ReCinerA : )EMEG O MXPi%o
: ReCinerA Co;@resse" Air SAste; U@<ra"e an" EP@ansion O Barran%a#er;eNa ReCinerA ECO)ETROL: Colo;#ia
: ReCinerA 5ater SAste; U@<ra"e an" EP@ansion : Barran%a#er;eNa ReCinerA ECO)ETROL: Colo;#ia
: ReCinerA 5ater SAste; U@<ra"e an" EP@ansion : Barran%a#er;eNa ReCinerA ECO)ETROL: Colo;#ia
Q )ersonnel A";inistration
Q S!# %onta%tor A";inistration
Q CISU $!n%tional A@@raisal
Co;;issionin< an" Start U@ Mana<er O VInter%onne%tion oC Central:EasternD5estern 6as Trans@ort SAste;s &ICO )roNe%t'W
E)C )roNe%t %onsists in t>e installation an" Start U@ t>ree <as %o;@resse" @lants &11 %o;@ressors O 1,19111 *) ISO7 total %a@a%itA' in%l!"in< a!PiliarA an"
!tilities sAste;s9 )ro%ess2 DeCinition in%l!"es o@eratin< sAste;s7 #!siness @lannin<7 @re@aration oC "o%!;entation an" @ro%e"!res7 @ro"!%tion an"
"evelo@;ent oC t>e MatriP oC Control an" )!n%> List ;ana<e;ent7 "raCtin< %ontra%ts instr!;entation7 ele%tri%al an" ;e%>ani%al @arts an" s@are "eCinition oC
CISU7 i;@le;entation oC a%tivities oC )re:Co;;issionin<7 Co;;issionin<7 Start!@ I Testin< @ro@er C!n%tionin<7 "evelo@;ent oC SAT tests Eit> ven"ors7
Develo@;ent oC )roNe%t Dossiers Closin< a;on< ot>ers9
$ROM
12
MO9
YR9 211. TO 11
MO9

YR9 211. MOST RECENT )OSITION )ro%esses
En<ineerin< Lea"er
SALARY MAY 5E CONTACT4
YES NO

NAME O$ EM)LOYER Dite%>7 S9A DCara%as O
3eneM!ela
TY)E O$ BUSINESS SU)ER3ISORLS NAME

SU)ER3ISORLS TITLE
ADDRESS BUSINESS )*ONE REASON $OR LEA3IN6
6I3E DETAILS O$ RES)ONSIBILITIES7 DUTIES7 AND ACCOM)LIS*MENTS )re@are" an" s!@@orte" in t>e @re@arations oC te%>ni%al servi%e @ro@osals
an" R!otations Cor
3r" @arties9
Q Trainer Cor NeE )ro%ess En<ineers O *i<> )erCor;an%e J!niors )ro<ra; O ReCinerA7 *aMo@
I Utilities Mo"!les9
Q 6!arantee" ti;elA @roNe%ts ePe%!tions at ;ini;!; %ost an" >i<> R!alitA &@ro%ess area'
Q Res@onsi#le Cor t>e "evelo@;ent oC #asi% an" "etaile" en<ineerin< oC neE @roNe%ts an" neE
eR!i@;ents installation9
: NeE S!lC!ri% A%i" )lant &29111 TMD' O En<ineerin<7 )ro%!re;ent I Constr!%tion
: 6as I Con"ensate *an"lin< Cor Seven O@erative Centers &2-11 MMSC$D'
Con%e@t!al7 Basi% I Detail En<ineerin<
: Basi% En<ineerin< Cor NeE 0t> S!lC!r Re%overA Unit al tail 6as Treat;ent Unit $ront:
En" &Sin%or U@<ra"e EP@ansion )roNe%t'9
: )irital DeE @ointin< Control )lant &31 MBD' O Con%e@t!al En<ineerin< RevieE an"
NeE )ro%ess S%>e;e Develo@;ent9
: Jose CrAo<eni% Co;@leP O 3is!aliMation )roNe%t : In%rease Ca@a%itA in N6L
$ra%tionation $a%ilities &211 MBD'
: Sta9 BHr#ara NeE N6L )i@eline &231 MBD' : 3is!aliMation )roNe%t
: LN6 EPtra%tion NeE Te%>nolo<ies Eval!ation9
IF ADDITIONAL SPACE IS REQUIRED, PLEASE ATTACH A SEPARATE PAGE.
I UNDERSTAND MY EMPLOYMENT IS AT WILL AND CAN BE TERMINATED AT ANYTIME AT EITHER THE COMPANY'S OR MY OPTION. I
UNDERSTAND THAT NO REPRESENTATIVE, OTHER THAN THOSE SPECIFICALLY AUTHORIED BY THE COMPANY, HAS ANY AUTHORITY TO
ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME OR TO MA!E ANY AGREEMENT CONTRARY TO THE
FOREGOING. IT IS MY UNDERSTANDING THAT ANY VERBAL REPRESENTATIONS MADE TO ME ARE NOT BINDING UPON THE COMPANY.
I UNDERSTAND T*AT AN O$$ER O$ EM)LOYMENT BY 5ORLEY)ARSONS MAY BE CONTIN6ENT U)ON2 T*E SUCCESS$UL COM)LETION O$ A
TOGICOLO6ICAL TEST $OR SUBSTANCE ABUSE7 5*IC* ALSO INCLUDES ALCO*OLY T*E SATIS$ACTORY COM)LETION O$ EM)LOYMENT AND
DE6REE 3ERI$ICATIONS AND SUBMISSION O$ SATIS$ACTORY )ROO$ O$ MY IDENTITY AND LE6AL AUT*ORI(ATION TO 5OR8 IN T*E UNITED
STATES9 I UNDERSTAND T*AT I$ ANY O$ T*E ABO3E NOTED CONTIN6ENCIES ARE NOT SUCCESS$ULLY COM)LETED OR I$ I *A3E MADE ANY
$ALSE STATEMENTS ON T*IS A))LICATION7 ANY O$$ER O$ EM)LOYMENT 5ILL BE RETRACTED OR MY EM)LOYMENT TERMINATED9
5ORLEY)ARSONS *AS A T*REE STE) EM)LOYEE DIS)UTE RESOLUTION )RO6RAM7 INCLUDIN6 $REEDOM O$ EG)RESSION I A))EAL7
MEDIATION7 AND ARBITRATION7 AS T*E EGCLUSI3E MEANS O$ RESOL3IN6 5OR8)LACE DIS)UTES9 T*AT MEANS7 I$ I ACCE)T EM)LOYMENT7 I
A6REE TO RESOL3E ALL LE6AL CLAIMS A6AINST 5ORLEY)ARSONS T*ROU6* T*IS )ROCESS INSTEAD O$ T*E COURT SYSTEM9
MY SI6NATURE BELO5 INDICATES T*AT I *A3E READ7 UNDERSTOOD AND A6REED 5IT* T*E ABO3E NOTED CONDITIONS9
PROOF OF IDENTITY AND LEGAL AUTHORIATION TO WOR! IN THE UNITED STATES ARE REQUIRED UPON REPORTING TO WOR!.
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