Last Name:

City:

Zip:

SSN #:

Are you over 18 years old?  Yes  No

Are you a U.S. Citizen?   Yes  No

Are you authorized to work in the U.S. on an unrestricted basis?   Yes  No

Have you ever applied here before?  Yes  No

Have you ever worked in the marine transportation industry?  Yes  No

Forklift/Winch    Crane Operator    Laborer    Clerk/Checker    Office    Maintenance

If applying for forklift operator, are you certified?  Yes  No

If yes, what size/type? 

Are you certified to operate a truck or yard hustler?  Yes  No

Do you have a CDL License?  Yes  No

Can you operate ship's cranes or shore cranes?  Yes  No

If yes, what type of cranes? 

****If applying for clerk/checker or office positions please continue. All others proceed to †

Do you have shipping/receiving experience?  Yes  No

If yes, what kind? 

Do you have any computer experience?  Yes  No

If yes, list experience:

List any other specific skills and or qualifications:

†

Is there any reason why you would be unable to perform, or to perform safely, any of the duties of the position for which you are applying for?  Yes  No

If yes, please explain:

Date available for employment:

Present employer:

Address:

Phone number:

- -

Previous employer:

Address:

Phone number:

- -

Previous employer:

Address:

Phone number:

- -

May we contact your present and/or previous employer?  Yes  No

City/State

Degree

Graduated

Date

Yes  No

Yes  No

Have you ever been arrested or convicted of a crime, excluding misdemeanors and traffic offenses?

Yes  No     If yes, explain:

I hereby authorize any prior employers to provide such information concerning my employment with them as may be requested, and also authorize any Registrar/Placement Office of any educational institutions attended to release an official copy of my transcripts and, if available, faculty appraisal.