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.