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Employment Application
First Name
(required)
Middle Initial
Last Name
(required)
Social Security No.
(required)
Are you 18 or older?
Yes
No
Mailing Address
Apartment Number
City
State
Zip Code
phone
Cell Phone
Emergency Contact Name
Emergency Contact Number
Email Address
(valid email required)
Do You have a valid Twic Card
Yes
No
If you have a valid twic card what is the date of expiration.
Do you have a valid Drivers License
Yes
No
If no valid drivers license please explain.
Drivers License Number
State of Issue
Date of Expiration
Position applied for:
Captain
Tonage
Deckhand
Engineer
Expected Pay Rate
Date Available
Desired Schedule
14/7
28/14
Other
Have you ever worked for this Company before?
Yes
No
If so when
Are you a citizen of the United States?
Yes
No
If no do you posses a valid visa or alien registration card permitting you to work in the United States?
Yes
No
Alien Card Number
Expiration date
Criminal Background
Have you ever been convicted of a felony?
Yes
No
If yes please explain.
Do you have any special circumstances that may prevent you from working all of your scheduled work, including extra hitches?
Yes
No
If yes please explain
Education
High School Name
Year Completed
College Name
Year Completed
Degree Acquired
Training
Year Completed
Degree Acqired
Other
Year Completed
Degree Acquired
Work History
List all jobs starting with your current or most recent employer. Fill in all blanks completely. List all of your employment history, even if it is not related to the Marine or Towing Industry. All gaps of employment will be questioned
Current or most Recent Employer
Phone
Address
Supervisor
Job Title
Starting salary
Ending Salary
Responsibilities
Date of hire
Date of separation
Reason for leaving
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