Please fill out the
application to the best of your ability. Please be aware that
failure to complete the application fully may delay processing of your
application.
Applicant Information
Full Name:
Last First
M.I.
Today's Date:
Address:
Street Address
Apartment/Unit #
City State
Zip Code
E-mail Address:
Phone:
Fax Number:
Date Available:
Position Applying for:
Please select from the list below the position you
would like to apply for. If you are interested in applying for a position
on the Vessel Side, please contact the Seafarers International Union at: (810) 794-4988
Social Security No.:
Desired Salary or Hourly Rate:
Did anyone refer you to us?
Do you have a Merchant Mariner Document (MMD)
If not, are you willing to apply for one?
For information regarding
how to get an MMD, please visit the following
website:
http://www.uscg.mil/stcw
Are you a citizen of the U.S.?
If not, are you authorized to work in the U.S.?
Have you ever worked for this company?
If yes, when?
Have you ever been convicted of a felony?
If yes, explain:
Education
High School:
City & State:
Dates Attended:
From:
To:
Degree:
Did you graduate?
YES NO
College:
City & State:
Dates Attended:
From:
To:
Degree:
Did you graduate?
YES NO
Other:
City & State:
Dates Attended:
From:
To:
Degree:
Did you graduate?
YES NO
Professional References
Please list two professional references:
Reference 1:
Full Name:
Relationship:
Phone:
Company:
Address:
Reference 2:
Full Name:
Relationship:
Phone:
Company:
Address:
Previous Employment
Most Recent:
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
Dates Employed:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES NO
2nd Recent:
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
Dates Employed:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES NO
3rd Recent:
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
Dates Employed:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES NO
Other Information
Please summarize your special skills, training, licenses and
qualifications
Disclaimer and Signature
By printing your name and
entering the date below, you are electronically signing your application.
By clicking 'Submit' below, you are agreeing to the following:
I certify that my answers are
true and complete to the best of my knowledge.I authorize you to make such
investigations and inquiries of my personal, employment, educational,
financial, or medical history and other related matters as may be necessary
for an employment decision.I
hereby release employers, schools or persons from all liability when
responding to inquiries in connection with my application.
In the event I am employed, I
understand that false or misleading information given in my application or
interview(s) may result in discharge.