US DEPARTMENT OF STATE CONSULAR 2X2 WHITE BACKGROUND PICTURE(EDITED TO FORMAL ATTIRE)
ELECTRONIC APPLICATION CENTER NOTE: NO VISIBLE TEETH, NO ACCESSORIES, NO HAIR COVERING THE
NONIMMIGRANT VISA APPLICATION FACE.
PERSONAL INFORMATION PLEASE WRITE LEGIBLY
FAMILY NAME CADAG
GIVEN NAME MARK ACE
MIDDLE NAME PAMITTAN
GENDER MALE
MARITAL STATUS MARRIED
DATE OF BIRTH (dd/mm/yyyy) 16/07/1992
COMPLETE ADDRESS 199E NOAH CMPD. DAO ST.
MARIKINA HEIGHTS, MARIKINA CITY
POSTAL / ZIP CODE 1810
MOBILE NUMBER +63 928 174 9511
EMAIL ADDRESS
[email protected]PASSPORT NUMBER P5871543B
ISSUED DATE 27 NOV 2020
EXPIRATION DATE 26 NOV 2030
HAVE YOU EVER LOST/STOLEN A PASSPORT
IF YES: PLACE OF ISSUANCE NO
ISSUANCE/EXPIRATION DATE
REASON
PASSPORT NUMBER
IF NO: PLEASE WRITE NO
NEW CONTRACT INFORMATION
JOINING DATE 8 NOV 2023
JOINING PORT PORT CANAVERAL, FLORIDA
JOINING VESSEL DISNEY WISH
HAVE YOU EVER BEEN IN THE US? / YES _ NO
LAST 5 ENTRIES IN THE US DATE OF ARRIVAL
(dd/mm/yyyy)
02/ 02 / 2023 _
20 / 06 /2022 _
/ / _
/ / _
/ / _
HAVE YOU EVER BEEN REFUSED/DENIED A US VISA?
_/ NO
_ YES; REASON:
FATHER'S FULL NAME ANTONIO_ / MORAL CADAG _
first name middle name last name
DATE OF BIRTH (dd/mm/yyyy) 25/05/1950
IS YOUR FATHER IN THE US? YES / NO
MOTHER'S MAIDEN NAME LUCIA _/ PAMITTAN LATAUAN_
first name middle name last name
DATE OF BIRTH (dd/mm/yyyy) 09/01/1955 _
IS YOUR MOTHER IN THE US? YES / NO
SPOUSE'S MAIDEN NAME MARYNEL _ / CABSAG GRIEGO _
first name middle name last name
DATE OF BIRTH (dd/mm/yyyy) 10/09/1991
PLACR OF BIRTH QUEZON CITY
NATIONALITY FILIPINO
SPOUSE'S ADDRESS 199E NOAH CMPD. DAO ST.
MARIKINA HEIGHTS, MARIKINA CITY
DO YOU HAVE ANY IMMEDIATE RELATIVES IN THE US?
_ / NO
_ YES; NAME:
RELATIONSHIP: _
CITIZENSHIP STATUS: _
WORK EXPERIENCE
CURRENT POSITION
SEAFARER-WIPER _
BRIEFLY DESCRIBE YOUR DUTIES MAINTAINING CLEANLINESS OF ENGINE _
SPACES AND ASSISTING IN ENGINEERING RELATED JOBS .
EMPLOYER AND EMPLOYER'S ADDRESS TDG CREW MANAGEMENT INC.
UNIT 803, 8TH FLOOR REACH BLDG., MACAPAGAL BLVD.,
BRGY. 76, ZONE 10, PASAY CITY 1709
SOCIAL MEDIA ACCOUNT NAME
FACEBOOK ACE CADAG
INSTAGRAM
OTHERS
FOR REIMBURSEMENT (BDO and BPI only)
ACCOUNT # : 004511050794
ACCOUNT NAME: MARK ACE CADAG
BANK/BRANCH: BDO LUNETA-TM KALAW
EMPLOYMENT HISTORY (please provide last 2 employers before TDG CM)
NAME OF COMPANY PHILIPPINE TRANSMARINE CARRIERS
ADDRESS BAGTIKAN STREET, MAKATI CITY
POSITION / JOB TITLE SEAFARER - WIPER
CONTACT PERSON ARMANDO PINEDA
DATE OF ATTENDANCE (from) MARCH 2014
DATE OF ATTENDANCE (to) MARCH 2021
BRIEFLY DESCRIBE YOUR DUTIES TAKING DAILY PARAMETERS, SOUNDING, INVOLVED
_ IN MANOEUVRINGS, CLEANING ENGINE SPACES
NAME OF COMPANY
ADDRESS
POSITION / JOB TITLE
CONTACT PERSON
DATE OF ATTENDANCE (from)
DATE OF ATTENDANCE (to)
BRIEFLY DESCRIBE YOUR DUTIES
EDUCATION
COLLEGE
NAME OF INSTITUTE TECHNOLOGICAL INSTITUTE OF THE PHILIPPINES
ADDRESS AURORA BLVD, QUEZON CITY
DEGREE / COURSE BS MARITIME ENGINEERING
DATE STARTED 2009
DATE GRADUATE 2012
_
_
HIGH SCHOOL
NAME OF INSTITUTE ROOSEVELT COLLEGE MARIKINA
ADDRESS J.P RIZAL, MALANDAY, MARIKINA CITY
DEGREE / COURSE SECONDARY EDUCATION
DATE STARTED 2005
DATE GRADUATE 2009
HAVE YOU TRAVELED TO ANY COUNTRIES WITHIN THE LAST FIVE (5) YEARS?
IF YES, PLEASE PROVIDE 5 COUNTRIES U.S.A
THE NETHERLANDS
INDIA
PAKISTAN
SRI LANKA
