Application for Employment
Last Name:
First Name:
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?
Date of Birth:
mm/dd/yyyy
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 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 #
Emergency Contact Information
Emergency Contact Name:
Relationship:
Emergency Contact Address:
Emergency Contact Phone Number:
Qualifications
Do you have a marine license?:
Select
No
Yes
Tonnage or Type:
"Z" Card Number:
AB Ticket?:
No
Yes
Job Preferences
Schedule Requested:
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:
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
STCW '95 Training Received
Course Subject
Conducted by:
Year Completed
Expiration Date
STCW
BST
DPind (Dynamic Positioning Induction (Basic)
DPSim (Dynamic Positioning Simulator (Advanced)
DPOper (Dynamic Positioning Operator's Certificate)
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.