Port Ship Service Inc. 

Employment Application

 

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

Today's Date

Month/Day/Year

First name
Street address
Last name
Address (cont.)
Middle initial
City

 

State/Province
Home Phone
Zip/Postal code
Work Phone
Country
Fax
Sex Male Female
E-mail

If you are under 18, and it is required, can you furnish a work permit? Yes No
If no, please explain
Have you ever been employed here before? Yes No
If yes give dates and positions.
Are you Legally eligible for employment in this country? Yes No
Date you are available to start work? mm/dd/yy
What is your desired salary range?
Type of employment desired?
Are you able to meet the attendance requirements of the position? Yes No

Have you ever pled "GUILTY" or "NO CONTEST" to, or been convicted of a crime?

Yes nnnnnnnnnnnnnnnNO

If yes, please provide date(s) and details

(Answering yes to these questions does not constitute an automatic bar to employment. factors such as date of the offence, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account)

Driver's License number if driving is an essential job function
State Driver's license was issued in

Job History

Start with the most recent and give us the last 4.

Employer Name
Address
Telephone Number
Position
Description for position
Start date
Ending date
Starting salary
Starting Rate of Pay hourly weekly
Ending salary
Ending Rate of Pay hourly weekly
Your immediate supervisor and title
May we contact for a reference?
Reasons for leaving

 

Employer Name
Address
Telephone Number
Position
Description for position
Start date
Ending date
Starting salary
Starting Rate of Pay hourly weekly
Ending salary
Ending Rate of Pay hourly weekly
Your immediate supervisor and title
May we contact for a reference?
Reasons for leaving

 

Employer Name
Address
Telephone Number
Position
Description for position
Start date
Ending date
Starting salary
Starting Rate of Pay hourly weekly
Ending salary
Ending Rate of Pay hourly weekly
Your immediate supervisor and title
May we contact for a reference?
Reasons for leaving

 

Skills and Qualifications

Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

Educational Background
*** only if job related ***
Name and Location Years Attended Did you Graduate Cources Studied
High School Yes No
Collage        Degree Major
Other           Yes No
References
3 people that have know you at least a year and you are not related to you and whom you have not previously worked for.
Name and Address Telephone number Years Known

Applicant Statement

timmyI certify that all information I have provided in order to apply for and secure work whit the employer is true.,complete and correct.

timmyI understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (I) cancel further consideration of this application, or (II) immediately discharge me from the employer’s services, whenever it is discovered.

timmyIf I an hired, I understand that I am free to resign at any time , with or without cause and/or prior notice, and the employer reserves the same right to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express languag are valid unless they are in writing and signed by the employer's president.

timmyI also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.

 

DO NOT SEND THIS APPLICATION UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understanding and accept all terms of the forgoing Applicant Statement.

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