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Screening Date:____________________ CST Member:____________________ Linguist:____________________
ADMINISTRATIVE DATA
FIRST NAME KUWAIT CIVIL ID # EMPLOYER /COMPANY
MIDDLE NAME N/A DATE OF BIRTH PLACE OF EMPLOYMENT KUWAIT
LAST NAME CITY OF BIRTH BASE CAMP
TRIBE NAME (If Applicable) N/A COUNTRY OF BIRTH DATE OF HIRE
NICK NAME (If Applicable) N/A NATIONALITY INDIAN POSITION
HEIGHT (feet’inches”) ETHNICITY ASIAN COMPANY BADGE #
WEIGHT (in lbs.) RELIGION EXPIRATION DATE
HAIR COLOR BLACK CELL/MOBILE PHONE BASE BADGE#
EYE COLOR BLACK E-MAIL ADDRESS EXPIRATION DATE
GENDER MALE WORK PHONE POC/SUPERVISOR NAME
EDUCATION LEVEL HOME PHONE POC/SUPERVISOR PHONE
MARITAL STATUS Married PHONE# - HOME COUNTRY POC/SUPERVISOR EMAIL
LANGUAGES PROFICIENCY VEHICLE (WORK / PERSONAL) PASSPORT
English PROFICIENT MAKE NUMBER
Hindi Native MODEL ISSUE DATE
YEAR EXPIRATION DATE
COLOR COUNTRY
VEHICLE PLATE# PREVIOUS
DRIVER LICENSE#
EMPLOYMENT HISTORY
(10-year work history; must include dates employed, position, city (physical location), country (physical location), company name, supervisor)
FROM (MMM/YY) TO (MMM/YY) POSITION CITY COUNTRY COMPANY / ORGANIZATION SUPERVISOR
RESIDENCES
(10-year residential history; at a minimum list primary address in each city)
FROM (MMM/YY) TO (MMM/YY) CITY COUNTRY ADDRESS / HOUSE NUMBER, BLDG / BLOCK #, STREET, NEIGHBORHOOD / DISTRICT
FATHER
MOTHER
Brother
Wife
Daughter
REFERENCES
(List 2 personal references and 1 professional reference not listed above.)
RELATIONSHIP AGE FIRST NAME MIDDLE NAME LAST NAME EMPLOYMENT / PROFESSION ADDRESS
FRIEND
FRIEND
FRIEND
TRAVEL
(10-year travel history; must include dates, country, city, purpose of trip, location of stay, other travelers)
FROM (MMM/YY) TO (MMM/YY) COUNTRY CITY PURPOSE LOCATION OF STAY (hotel name / apartment #) COMPANIONS
MILITARY HISTORY
FROM (MMM/YY) TO (MMM/YY) COUNTRY BRANCH RANK POSITION / DUTY TITLE UNIT / CITY