Peninsula Marine, Inc.

Employment Application

Full Name:

  ___________________________

 ________________________________

 

 Date:

 _______________


Last

First

M.I.

 

 
Physical & Mailing



Street Address _______________________________________

Apartment/Unit #______

 

 

 

 

 

City______________________________

State ___________

ZIP Code _________

Phone:

 ____________________________

 Email

:____________________Date of Birth:

Date Available:

 __________

 Social Security No.: ________

 

 TWIC:  Yes or No:_____

 

Position Applied for:

 ____________________________________________________________________________

Are you a citizen of the United States? ____________

YES

NO

 If no, are you authorized to work in the U.S.? _____________

YES

NO

Have you ever worked for this company? ___________

YES

NO

 If yes, when?

 _________________________________

Have you ever been convicted of a felony? _______________

YES

NO

 

If yes, explain:

 _______________________________________________________________________________________________
Education             ____________________________________________________________________________________________________

High School:

 _____________________________

 Address:

 _____________________________________

From:

 _____

 To:  _______Did you graduate?______

YES

NO

 Diploma:

 __________

College:

 _______________

 Address:

______________________________________

From:

 _____

 To:

 ________

 Did you graduate? ______

YES

NO

 Degree:

 __________

Other:

 ______________

 Address:

 _____________________________________

From:

 _________

 To:

 _________

 Did you graduate? ______

YES

NO

 Degree:

 __________
References

Full Name:

 _________________________________________________________________________

 Relationship:

 _______________

Company:

 _________________________________________________________________________

 Phone:

 _______________

Address:

 _________________________________________________________________________

  

 

 

 

 

 

Full Name:

 _________________________________________________________________________

 Relationship:

 ________________

Company:

 _________________________________________________________________________

 Phone:

 ________________

Address:

 _________________________________________________________________________

  

 

 

 

 

 

Full Name:

 _________________________________________________________________________

 Relationship:

 ________________

Company:

 _________________________________________________________________________

 Phone:

 ________________

Address:

 _________________________________________________________________________

  

 
Previous Employment

Company:

 _________________________________________________________________________

 Phone:

 _________________

Address:

 _________________________________________________________________________

 Supervisor:

 _________________

Job Title:

___________________________

 Starting Salary:

$___________

 Ending Salary:

$______________

Responsibilities:

 ________________________________________________________________

From:

 

 To:

 

 Reason for Leaving:

 

May we contact your previous supervisor for a reference?

YES

NO

 

 ________________________________________________

 _________

 _________

 

 

 

 

 

Company:

 _____________________________________________________________

 Phone:

 _______________

Address:

 _____________________________________________________________

 Supervisor:

 _______________

Job Title:

 _________________________

 Starting Salary:

$______________

 Ending Salary:

$ _________

Responsibilities:

 ______________________________________________________

From:

 _____________

 To:

 _________________

 Reason for Leaving:

 _______________________

May we contact your previous supervisor for a reference?

YES

NO

 

 _______________________________________________________

 ________

 _________

 

 

 

 

 

Company:

 ________________________________________________

 Phone:

 _____________

Address:

 ________________________________________________

 Supervisor:

 _____________

Job Title:

 ___________________________

 Starting Salary:

$____________

 Ending Salary:

$_______________

Responsibilities:

 ___________________________________

From:

 ______________

 To:

 ______________

 Reason for Leaving:

 _____________________

May we contact your previous supervisor for a reference?_______________

YES

NO

 
Military Service______________________________________________

Branch:

 ______________________________________________

 From:

 ___________

 To:

 __________

Rank at Discharge:

 ________________________

 Type of Discharge:

 ___________________

If other than honorable, explain:

 __________________________________________________________________
Disclaimer and Signature ______________________________________________________

Signature:

 ____________________________________________________________

 Date:

 ________________

 


 

Please list three professional references.

 

 

 

 

 

 

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.