Application for Employment
Last Name:
Suffix:
First Name:
Middle Initial:
SSN:
Street Address:
City:
State:
Zip:
How long have you lived at your present address??
If less than 5 years, please give additional addresses for the past 5 years:
Address #1:
Address #2:
E-Mail Address:
Telephone #:
Alternate Phone #:
Where can you be reached on short notice?
Where did you hear of Otto Candies LLC???
Have you ever worked for Otto Candies?:
No
Yes
If yes, please list work time. I worked for Otto Candies from
to
mm/dd/yyyy
Reason for Leaving:
Have you ever been convicted of a felony?:
No
Yes
If so, please explain:
Do you have any objection to working foreign?
Do you have relatives working for Otto Candies?
No
Yes
Please list:
Do you have a current Drivers License?:
Select
No
Yes
DL #:
State:
Do you have an automobile:
No
Yes
License plate #:
Estimated drive time from your home to our office:
Do you have a valid passport?
No
Yes
Passport #
Are you 18 years old or older?
No
Yes
Emergency Contact Information
Emergency Contact Name:
Relationship:
Emergency Contact Address:
Emergency Contact Phone Number:
Qualifications
If you have a marine license click
'Yes'
or if not
'No'.
Exp. Date:
Exp. Date:
Exp. Date:
Exp. Date:
Exp. Date:
Exp. Date:
Add Another License
"Z" Card Number:
Exp. Date:
Type (OS-AB-QMED):
STCW '95: Yes
No
Nautical Institute DP Operator:
Limited
Unlimited
N/A
Job Preferences
Schedule Requested:
56/28
28/28
28/14
14/14
Schedule Second Choice:
56/28
28/28
28/14
14/14
Position or type of work requested:
CAPT
MATE
Chief Engr
1st Asst Engr
OILER
A/B
O/S
O/S Crane Operator
Second Choice:
CAPT
MATE
Chief Engr
1st Asst Engr
OILER
A/B
O/S
O/S Crane Operator
Employment History
Job # 1
Employer Name:
Supervisor's name:
Employer Address:
Starting Date:
Ending Date:
Position:
Ending Salary:
Job # 2
Employer Name:
Supervisor's name:
Employer Address:
Starting Date:
Ending Date:
Position:
Ending Salary:
Job # 3
Employer Name:
Supervisor's name:
Employer Address:
Starting Date:
Ending Date:
Position:
Ending Salary:
Job # 4
Employer Name:
Supervisor's name:
Employer Address:
Starting Date:
Ending Date:
Position:
Ending Salary:
Job # 5
Employer Name:
Supervisor's name:
Employer Address:
Starting Date:
Ending Date:
Position:
Ending Salary:
Education
Elementary School (Grades 1-8)
Highest Grade Completed:
8
7
6
5
4
3
2
1
Name of School:
High School (Grades 9-12)
Highest Grade Completed:
12
11
10
9
Name of School:
College
# of years attended:
Name of School:
Major:
Completed Degree?:
No
Yes
Other
# of years attended:
Name of School:
Major/Specialty:
Completed Degree or certification?:
No
Yes
Give below a list of all STCW or Marine related training which is relevant to performing the job for which you are applying
STCW / Course Subject
Conducted by:
Year Completed
Expiration Date
Basic Safety Training
Dynamic Position Induction
Dynamic Position Advanced
DP Equipment Operator
GMDSS
ARPA
VSO
Military Record
Branch
From
To
Rank
Type of discharge
Reservist Obligation?
No
Yes
No
Yes
No
Yes
I have reviewed this application, and it is accurate to the best of my knowledge.
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