Job Application Form - Steiner Shipyard

Basic Details
Background
Employment History
Terms and Conditions

Name

Position Applied For

Application Date

Referral Source *

Name of Source

(if applicable)

First Name

Middle Name

Last Name

Social Security Number

Street Address

City

State

Zip Code

Are you at least 18 years of age? *

Yes No

Primary Phone

Secondary Phone

Can be beeper or other device

Best Time to Call

Please indicate AM or PM

Have you submitted an application here before? *

Yes No

Have you ever been employed here before? *

Yes No

Are you legally eligible for employment in this country? *

Yes No

Have you ever pled *

Yes No Answering "yes" to this question does not constitute an automatic bar to employment. Factors such as the 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

Drivers License State

Date Available for Work *

Are you a Veteran of any war, campaign, or expedition? *

Yes No

Are you a Vietnam-era Veteran? *

Yes No

Are you a Special Disabled Veteran *

Yes No

What is your desired salary range? *

All jobs require the following physical requirements:

Be able to lift 50lbs
Be able to stand, bend, stoop, squat, or kneel regularly
Be able to climb stairs and ladders

Are you able to meet these Physical Requirements? *

Yes No

Educational Background

List the last three (3) schools attended, starting with the most recent.
If no GPA, please give the class ranking. For Studies, please note your major and/or minor

Name of School 1

Years Completed School 1

Diploma School 1

GPA School 1

Studies School 1

Name of School 2

Years Completed School 2

Diploma School 2

GPA School 2

Studies School 2

Name of School 3

Years Completed School 3

Diploma School 3

GPA School 3

Studies School 3

References

List the name and telephone number of three business/work references who are NOT related to you and are NOT previous supervisors. If not applicable, list three school or personal references who are NOT related to you.

Reference 1 Name

Reference 2 Name

Reference 3 Name

Reference 1 Phone

Reference 2 Phone

Reference 3 Phone

Ref 1 Years Known

Ref 2 Years Known

Ref 3 Years Known

Employment History

Provide the following information of your past and current employers, assignments, or volunteer activities, starting with the most recent.
For Pay, please give hourly rate or salary and the period (per hour, per month, per year, etc.)
You can add any general comments about your employment in the comments section below, including explanations of any gaps in employment.

Employment Comments

Employer 1 Name

Employer 1 Address

Employer 1 Summary of Work

Type of work, job responsibilities, etc.

Employer 1 Starting/Final Job Titles

Employer 1 Immediate Supervisor and Title

Employer 1 Reason for Leaving

Employer 1 Phone

Employer 1 Start Date *

Employer 1 End Date *

Contact Employer 1? *

Yes No Later

Employer 1 Start Pay

Employer 1 End Pay

Employer 2 Name

Employer 2 Address

Employer 2 Summary of Work

Type of work, job responsibilities, etc.

Employer 2 Starting/Final Job Titles

Employer 2 Immediate Supervisor and Title

Employer 2 Reason for Leaving

Employer 2 Phone

Employer 2 Start Date

Employer 2 End Date

Contact Employer 2?

Yes No Later

Employer 2 Start Pay

Employer 2 End Pay

Employer 3 Name

Employer 3 Address

Employer 3 Summary of Work

Type of work, job responsibilities, etc.

Employer 3 Starting/Final Job Titles

Employer 3 Immediate Supervisor and Title

Employer 3 Reason for Leaving

Employer 3 Phone

Employer 3 Start Date

Employer 3 End Date

Contact Employer 3?

Yes No Later

Employer 3 Start Pay

Employer 3 End Pay

I agree to read the following terms and conditions

Yes