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Employment Application

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GENERAL INFORMATION

Name(Required)

First Last

Phone

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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You must be 21 or older to sell sensitive products. Are you 21 or older?

Yes

Desired Position(Required)

Desired Location

Have you ever worked for Maritime Energy before?(Required)

Yes

If yes, From Date

To Date

Address(es)

Reason for Leaving

AVAILABILITY

Are you legally able to be employed in the U.S.?(Required)

Yes

Total Hours Available Per Week(Required)

Hours Available (Ex. 8am-5pm)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

How Did You Hear of This Job?

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How Far Do You Live From Job?

Do You Have Reliable Transportation to Work?

Yes

SCHOOL MOST RECENTLY ATTENDED

School Name

Graduated?

Yes

Now Enrolled?

Yes

Address

Street Address Address Line 2 City State / Province / Region

Phone

Teacher or Counselor

Department

Last Grade Completed

Grade Point Average

Sports or Activities

THREE MOST RECENT JOBS

Company

Start Date

End Date

Job

Supervisor

Phone

Address

Street Address City State

Reason for Leaving

Company

Start Date

End Date

Job

Supervisor

Phone

Address

Street Address City State

Reason for Leaving

Company

Start Date

End Date

Job

Supervisor

Phone

Address

Street Address City State

Reason for Leaving

PROFESSIONAL REFERENCES

Name 1

First Last

Address

Street Address City State

Phone

Name 2

First Last

Address

Street Address City State

Phone

Name 3

First Last

Address

Street Address City State

Phone

EMPLOYEE REFERRAL

(Optional) Please enter the first and last name of the current Maritime employee who referred you.

The Secretary of Health and Human Services has determined that certain diseases, including hepatitis A, salmonella, shigella, staphylococcus, streptococcus, giardia, E.coli, and campylobacter may prevent you from serving food or handling food, food service equipment and utensils in a sanitary and healthy fashion. Is there a reason why you cannot perform the essential functions of this job?(Required)

Yes

If Yes, Please Explain

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During the past 7 years, have you been convicted of or pled guilty to a crime that would be relevant to the job you are applying for? Please exclude misdemeanors and traffic violations.

Yes

U.S. MILITARY

Branch of Service

Highest Rank

Date Entered

Date of Discharge

Do you have service-related skills and experience applicable to civilian employment?

Yes

If Yes, Please Describe

GENERAL

Please list additional licenses (Class A, B, Burner, etc.) and endorsements (HAZMAT, Propane, etc.).

What additional relevant experience or training have you had other than your work experience, military service, and education?

Activities - civic, athletic, fraternal, etc. that you feel are relevant to this position. (Exclude organizations which indicate race, religion, color, or national origin of members.)

Maritime Energy is an equal opportunity employer committed to a diverse work force. In order to assist in our efforts, we invite you to voluntarily provide responses to the following requests for information. Failure to respond will not subject you to adverse treatment. This form will be kept strictly confidential and will not be retained with your application. Information provided will be used only in accordance with law and for equal opportunity purposes.

Disabled Veteran

Vietnem-Era Veteran

By clicking "Submit", you agree to the following:

I certify that I have read and fully completed this application and that the information contained on this application is correct to the best of my knowledge and understand that any omission or erroneous information is grounds for dismissal in accordance with the policy of Maritime Energy.
I authorize the references listed on this application to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that result from furnishing same to you.
I understand that Maritime Energy operates with policies and procedures that will be explained to me in my probation period of 90 days. I agree to abide by all policies and procedures that are established.
I acknowledge that Maritime Energy reserves the right to amend or modify the policies in its handbook and other policies of Maritime Energy at any time, without prior notice. These policies do not create any promises or contractual obligations between Maritime Energy and its employees. At Maritime Energy, my employment is at will. This means I am free to terminate my employment at any time, for any reason, with or without cause, and Maritime Energy retains the same rights.

Maritime Energy is an Affirmative Action and Equal Opportunity Employer. Various Federal, State, and Local laws prohibit discrimination on account of race, color, religion, sex, age, national origin, disability, or veterans status. It is Maritime Energy's policy to comply fully with these laws, as applicable, and information requested on this application will not be used for any purpose prohibited by law.

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