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?:
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?:
If so, please explain:
Do you have any objection to working foreign?
Do you have relatives working for Otto Candies? Please list:
Do you have a current Drivers License?: DL #: State:
Do you have an automobile: License plate #:
Estimated drive time from your home to our office:
Do you have a valid passport? Passport #
Are you 18 years old or older?

Emergency Contact Information

Emergency Contact Name: Relationship:
Emergency Contact Address:
Emergency Contact Phone Number:

Qualifications

Exp. Date:
Exp. Date:
Exp. Date:
Exp. Date:
Exp. Date:
Exp. Date:
"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: Schedule Second Choice:
Position or type of work requested: Second Choice:

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: Name of School:

High School (Grades 9-12)

Highest Grade Completed: Name of School:

College

# of years attended: Name of School:
Major: Completed Degree?:

Other

# of years attended: Name of School:
Major/Specialty: Completed Degree or certification?:

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?

   I have reviewed this application, and it is accurate to the best of my knowledge.