2. Prenumele [First Name]: 3. Numele purtate anterior [Other names, maiden name]: - 4. Locul nasterii [Place of birth] Tara [Country]: Localitatea [town/village]: 5. Data nasterii [Date of birth]: 6. Parinti [parents]: tata [father]....................., mama [mother.................. 7. Cetatenia [citizenship]: 8. Nationalitatea [nationality]: 9. Documentul de trecere a frontierei [passport]: Nr.[No]....................., eliberat de autoritatile [issued by]................, la data [date]:.........................., valabil pana la [validity].............................. 10. Domiciliul [home address] Tara [country]......................., Localitatea [town/village]: 11. Ultima resedinta [last address]: Tara [country]......................., Localitatea [town/village]: 12. Stare civila [marital status]: .............., copii aflati in intretinere [children]..... 13. Calificari profesionale [professional qualifications]: 14. Traseu profesional (angajatori anteriori cu datele de identificare ale acestora, precum si functiile detinute) [Professional history (previous employers with respective identification data and positions held)]:
16. Limbi straine cunoscute [foreign languages]: 17. Alte mentiuni [other]: Declar pe proprie raspundere ca nu am antecedente penale, ca sunt apt de munca din punct de vedere medical si ca detin cunostinte de o limba de circulatie internationala [I declare that i have no criminal record, that I am medically able to work and I have minimal knowledge of an international language].