Application for Employment

 

Applicants are considered for all positions without regard to race, color, religion, age, sex, marital status, national origin, veteran status, sexual orientation, or the presence of a non-job related medical condition, disability, or handicap.

Thank you for completing this application form and for your interest in employment with our company. Employment will be subject to satisfactory reference checks and pre-employment examination that will include a drug and alcohol screening in accordance with state and federal law.

The applicant (upon approval of employment) understands that he/she will be immediately subjected to random drug and alcohol screening as required by the United States Coast Guard. (46 CFR 16.23 f)

 

Personal Information

Last Name
First Name
Middle Name
Street Address
 Email
City
State
Zip
Home Phone
Cell Number
Other Contact Number
Social Security Number (Optional)
Position Applied For
Source of Referral
 Date Available
 

Education

School Location Course Graduated? Degree, Diploma, or License
 

Past Employment

Start with present or most recent employer.

Employer
 Phone
 Employed Dates
From: - To:
Duties
 Reason for Leaving
Hourly Rate
Or Salary Rate Per Day
Supervisor
 
Employer
 Phone
 Employed Dates
From: - To:
Duties
 Reason for Leaving
Hourly Rate
Or Salary Rate Per Day
Supervisor
 
Employer
 Phone
 Employed Dates
From: - To:
Duties
 Reason for Leaving
Hourly Rate
Or Salary Rate Per Day
Supervisor
 

Special Skills and Qualifications

Summarize special skills, qualifications, licenses, professional, or business experiences that you think would especially qualify you for employment.



 

References

(Other than relatives)

Name Phone Occupation Years Known
 

Inland/Offshore Deckhand Check List

Every potential employee must complete the check list below. Every question must be answered.

Which vessel you have more experience on ?
Answer:

Can you swim ?
Answer:

Can you climb ladders ?
Answer:

Do you get seasick ?
Answer:

Do you get airsick ?
Answer:

Are you familiar with Material Transfer Procedures ?
Answer:

Are you capable of lifting 50 to 75 pounds frequently ?
Answer:

Can you handle lines to moor vessel to docks ?
Answer:

Can you tie vessel to vessel ?
Answer:

Can you handle lines to moor vessel to rigs or platforms ?
Answer:

Can you use a boat hook ?
Answer:

Are you capable of swinging by a hand rope from vessel to platform and platform to vessel ?
Answer:

Transfer by crane and basket by standing on outer rim of basket and grasping rope net ?
Answer:

Can you lower lifeboats in case of emergency ?
Answer:

Can you stand watch while underway ?
Answer:

Can you open and close valves by hand ?
Answer:

Can you load and unload cargo ?
Answer:

Can you lubricate machinery and equipment ?
Answer:

Can you use hand tools for maintenance ?
Answer:

Can you use a paint brush and rollers ?
Answer:

Can you clean using mops, brooms, brushes and fire hoses ?
Answer:

Can you follow direct orders without supervision ?
Answer:

Can you work the back deck ?
Answer:

Do you have a knowledge of shackles ?
Answer:

Do you have knowledge of rig moves ?
Answer:

Do you have knowledge of anchors ?
Answer:

Do you have knowledge of barges ?
Answer:

Inland Push Boats, Tow Boats, and Tugs: All duties as offshore deckhand plus

How many barges have you handled ?

Do you have experiences with any of the following: Please check off:

Can you make or break a tow ?
Answer:

 
  • I understand that employment will be subject to my submitting documentary proof of my identity and legal eligibility to work.
  • I understand that the employer follows an “employment at will” policy, in that I or the employer may terminate my employment at any time or for any reasons consistent with applicable state or federal laws.
  • I understand that this application is not a contract of employment.
  • I understand that the company will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me, and I release from all liability for damage in providing this information.
  • I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.
 
Full Name
 Today's Date
 Accept Terms?