Application for Employment

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.


Personal Information
Full Name:
 Last Name                 First NameM.I.
Today's Date: 
Address:
 Street AddressApartment/Unit #
 
 City                              StateZip Code
E-mail Address: 
Phone: 
Fax Number: 
Date Available: 
Position Applying for:***Please note: 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? If yes, who? 
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
Please provide information regarding your last three employers:
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.
Print Name:       
Date:   2010-03-10
      
 
 

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