Application for Employment
4025 13
th
Ave W. Seattle, WA 98119
Main Office 206-282-9979 or 800-544-2580 / Fax 206-283-9121
Please answer all questions COMPLETELY. Write in N/A where not applicable.
Last Name: First Name: Middle Initial:
Permanent Street Address:
Apt No:
City: State: Zip:
Home Phone:
Mobile Phone:
Email Address:
Do you have the legal right to work in the U.S.? (Proof of identity and legal right to work in the U.S. will be
required AFTER hire.) Yes No
Are you a former employee of this company? Yes No If yes, list past employment dates:
If so, under what name? From: To:
Do you have any relatives
or friends employed here?
Yes No
Name of relative or friend employed here:
How did you hear about us? Internet Word of Mouth Company Website Other
If other please provide:
POSITION(S) APPLIED FOR You must have a U.S. Coast Guard License or Certificate (MMC) for all positions except
deckhand, wiper and cook.
Captain
(Requires at least 500 ton
license)
Chief Engineer
(1500-3000 HP DDE
license okay)
(Requires at least 500
Second Mate (Requires at least
500 ton license)
A.B. Seaman (Requires Coast Guard
MMC, OSV, Towing, Fishing are okay)
Deckhand (No MMC Required)
QMED / Oiler (MMC required) Wiper (No MMC Required) Cook (No MMC Required)
What USCG license or certificate do you hold?
USCG License Description:
USCG Certificate (AB, QMED, etc.) Description:
Have you operated any of the below warehouse equipment (Please check all that apply and list others that
apply): Yard & Stay Cargo Gear Forklifts Manual / Electric Pallet Jacks
Other:
Please list work experience which may qualify you for this job:
EDUCATION Check here if you received a GED rather than graduating from high school .
School Name / City Did you graduate Major Area of Study
High School Yes No
College Yes No
Vocational Yes No
U.S. MILITARY SERVICE RECORD
Service Branch
Highest Rank or Rating
Training / Work Experience
Time of Service
EMPLOYMENT HISTORY Fill this section out completely even if you are submitting a resume.
.
Employer:
City / State:
Phone Number:
Title / Main Duties:
From:
To:
Supervisor’s Name
Reason for Leaving: Voluntary Resignation / Quit Lay-off Dismissed for Cause/Fired
Still Employed: Yes No If so, may we contact your employer? Yes No
Employer:
City / State:
Phone Number:
Title / Main Duties:
From:
To:
Supervisor’s Name
Reason for Leaving: Voluntary Resignation / Quit Lay-off Dismissed for Cause/Fired
Still Employed: Yes No If so, may we contact your employer? Yes No
Employer:
City / State:
Phone Number:
Title / Main Duties:
From:
To:
Supervisor’s Name
Reason for Leaving: Voluntary Resignation / Quit Lay-off Dismissed for Cause/Fired
Still Employed: Yes No If so, may we contact your employer? Yes No
Employer:
City / State:
Phone Number:
Title / Main Duties:
From:
To:
Supervisor’s Name
Reason for Leaving: Voluntary Resignation / Quit Lay-off Dismissed for Cause/Fired
Still Employed: Yes No If so, may we contact your employer? Yes No
DECLARATION Please read this carefully.
I certify that the information on this application is accurate and subject to verification. I understand that any misrepresentation or omission of facts or
circumstances regardless of time of discovery may be sufficient cause for termination. I understand that all new employees are on a probationary period
as outlined in the Employee Handbook. If hired, the employment is not for any specific period of time. Either party may terminate employment at any
time and for any reason. I understand and agree that employment is conditional upon my submitting to and passing a drug screen test and a criminal
background check. I understand that acceptance of this application by Coastal Transportation Inc. does not imply intention to hire me.
Signature of Applicant:
Date:
An equal opportunity employer In completing this application and in answering any questions during the hiring process please do not disclose any
disability you may have. If a job offer is made and you require reasonable accommodations, then at that time you should disclose any disability you have.
Reasonable accommodations which are not an undue hardship will be provided to disabled persons in accordance with the American Disabilities Act.
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