Peninsula Marine, Inc. |
Employment Application
Full Name: | ___________________________ | ________________________________ |
| Date: | _______________ |
| Last | First | M.I. |
|
|
Physical & Mailing | | |
| Street Address _______________________________________ | Apartment/Unit #______ |
|
| ||
| City______________________________ | State ___________ | ZIP Code _________ |
Phone: | ____________________________ | :____________________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: | _______________________________________________________________________________________________ |
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: | __________ |
Full Name: | _________________________________________________________________________ | Relationship: | _______________ |
Company: | _________________________________________________________________________ | Phone: | _______________ |
Address: | _________________________________________________________________________ |
| |
|
|
|
|
Full Name: | _________________________________________________________________________ | Relationship: | ________________ |
Company: | _________________________________________________________________________ | Phone: | ________________ |
Address: | _________________________________________________________________________ |
| |
|
|
|
|
Full Name: | _________________________________________________________________________ | Relationship: | ________________ |
Company: | _________________________________________________________________________ | Phone: | ________________ |
Address: | _________________________________________________________________________ |
|
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 |
|
Branch: | ______________________________________________ | From: | ___________ | To: | __________ |
Rank at Discharge: | ________________________ | Type of Discharge: | ___________________ |
If other than honorable, explain: | __________________________________________________________________ |
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.