Marine Based Application

General Information

Position(s) Applied For *

Referral Source *

Starting Salary Desired *

Name *

Social Security Number *

Street Address *

City *

State *

Zip *

How long have you lived at your present address?

Home Phone Number

Cell or other phone number *

Best time to contact you at home

Best time to contact you at work

Email Address

Are you at least 18 years old *

Yes

Have you ever been employed by James Marine, Paducah River Service, or Walker Towing before? *

Yes

If yes, please give company and dates.

Do you have a relative currently employed by James Marine Inc. / Paducah River Service? *

Yes

If so, please give name and company

Are you legally eligible for employment in this country? *

Yes

Date Available to Work *

Type of Employment Desired *

Full-time

Part-time

Temporary

Are you on layoff and subject to recall? *

Yes

Will you relocate if the job requires it? *

Yes

Will you travel if the job requires it? *

Yes

Will you work overtime if required? *

Yes

Have you ever been bonded? *

Yes

Have you ever been convicted of a felony? *

Yes

If yes, please explain.

Do you have a valid driver\'s license? *

Yes

Driver\'s License Number

State Issued

Employment History

Please list your last four employers

Employer 1

Address

Telephone

Job Title

Job Description

Immediate Supervisor and Title

Reason for Leaving

Starting Employment Date

Ending Employment Date

Starting Salary

Final Salary

May we contact references?

Yes

Employer 2

Address

Telephone

Job Title

Job Description

Immediate Supervisor and Title

Reason for Leaving

Starting Employment Date

Ending Employment Date

Starting Salary

Final Salary

May we contact references?

Yes

Employer 3

Address

Telephone

Job Title

Job Description

Immediate Supervisor and Title

Reason for Leaving

Starting Employment Date

Ending Employment Date

Starting Salary

Final Salary

May we contact references?

Yes

Employer 4

Address

Telephone

Job Title

Job Description

Immediate Supervisor and Title

Reason for Leaving

Starting Employment Date

Ending Employment Date

Starting Salary

Final Salary

May we contact references?

Yes

Educational Background

High School

Date Attended

Diploma

Grade Average

College

Date Attended

Degree

Grade Average

Major/Minor

Other

Date Attended

Degree

Grade Average

Major/Minor

References

Name

Phone

Years Known

Name

Phone

Years Known

Name

Phone

Years Known

Military Experience

Branch of Service

Dates of Service

Rank

Specialty

Additional Information

Please give us a brief list of special accomplishments, awards, licenses held, special skills, qualifications not previously mentioned, or any other general information you would like for us to consider:

Drug and Alcohol Abuse Statement

Safety is taken seriously at James Marine Inc. / Paducah River Service companies. It becomes critical where the health and lives of employees and fellow workers are affected by an employee’s actions.

Because of the importance of safety and sound business practices, we take a strong stand against the possession or use of alcohol or illegal drugs on Company time of property. We want to make sure that every employee and prospective employee understands our policy:

The possession, consumption or being under the influence of intoxicating beverages or illegal drugs on Company premises (including all Company owned or controlled vessels and property) are grounds for immediate discharge. This prohibition includes reporting to work under the influence.

As a safety precaution, access to Company premises (including vessels) is condition upon the Company’s right to search a person, vehicle or personal effects for intoxicating beverages or illegal drugs. From time to time, and without prior announcement, searches may be made of anyone boarding, entering, leaving or on the premises or property of the Company (including urinalysis drug screens or other testing). Refusal to cooperate in such a search (including urinalysis drug screens) is grounds for discharge.

Use of some illegal drugs is detectable for several days. Detection of such drugs will be considered as being under the influence. Job applicants will be subject to drug screening.

I have read and understand this policy and hereby agree to submit to drug testing at any time prior to, or during my employment. If employed, I further consent to search of my person and possessions while on Company property to determine if I have violated this policy.

Employee Release and Privacy Statement

I understand that the Company requires certain information about me to evaluate my qualifications for employment and to conduct its business if I become an employee. Therefore, I authorize the Company to investigate my past employment, educational credentials and other employment-related activities. I agree to cooperate in such investigations, and release those parties supplying such information to the Company from all liability or responsibility with respect to information supplied.

I understand that any false answers or statements made by me on this application or any supplement thereto or in connection with the above mentioned investigations will be sufficient grounds for immediate discharge, if I am employed.

I agree that the Company may use the information it obtains concerning me in the conduct of its business. I understand that such use may include disclosure outside the Company in those cases where its agents and contactors need such information to perform their functions, where the Company’s legal interests and/or obligations are involved, or where there is a medical emergency involving me. I hereby release the Company from any liability and agree to hold harmless any employee of the Company who furnished such information.

I understand that regular employment may be subject to satisfactory passing a physical examination conducted by a physician designated by the Company.

If I am employed and at any time suffer personal injuries for which I shall make a claim, I hereby agree to submit myself to examination by any doctor or doctors selected by the Company and as often as deemed necessary and requested. Any failure on my part to comply with this request shall result in my claim being considered waived and any legal action abated. I further agree that in case of injury, where insurance is carried under an employer’s compensation law, to waive all actions for damages and accept said insurance.

If hired, I agree to abide by Company policies, rules and regulations. I understand that employment is at will. Employment is not for a fixed time and may be discontinued, with or without notice or cause, by myself or the Company. I understand that no employee, officer, representative or publication may obligate the Company to anything contrary to the above.

Do you agree with all of the above statements? *

Yes

Full Name *

(electronic signature)

Date *

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