Employment Form – Port Ship Service, Inc.

Application for Employment

Personal Information

First Name

Last Name

Social Security:

Driver's License Number

State of Issue:

Expiration Date

Reationship Status

Phone/Mobile

Physical Address

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (if other thn Physical Address)

Address Line 1

Address Line 2

City

State

Zip Code

Identification Record

Hair Color

Eye Color

Height (In Inches)

Weight (In Pounds)

Describe any identifying birthmarks

Describe any identifying scars

In The Case of An Emergency, Notify:

First Name

Last Name

Relationship to Emergency Contact

Phone/Mobile

Emergency Contact Address

Address Line 1

Address Line 2

City

State

Zip Code

Citizenship

Are You a U.S. Citizen?

Do you have a Passport?

Passport #

U.S. Permanent Resident Alien?

Alien #

Citizenship

Job Position

What position are you applying for?

Do you have any physical limitations that we should be aware of?

Yes

If limited, please describe

Can you supply a letter from your former employer that we may copy for records?

Yes

Can you swim?

Yes

Have you ever worked offshore?

Yes

If you did work offshore, how long was it for?

Please select any licenses you currently hold:

Captain

Mate

Zcard

TWIC Card

Other

None

Captain License #

Mate #

Zcard #

TWIC Card #

Other License:

No Current Licensure

True

False

If you answered "false", please explain

Please attach a copy of your Driver's License

Choose File

Please attach a copy of your Driver's License

Choose File

Previous Employment

Employer's Name

Date Started

Date Left

Position Held:

Reason for leaving:

Employer's Name

Date Started

Date Left

Position Held:

Reason for leaving:

Employer's Name

Date Started

Date Left

Position Held:

Reason for leaving:

References

First Name

Last Name

Phone/Mobile

First Name

Last Name

Phone/Mobile

First Name

Last Name

Phone/Mobile

Job Description & Physical Requirements

Boat Captain

Are you able to climb ladders? It's a job requirement.

Yes

You must be able to perform moderate lifting at times. Ae you capable of lifting 50lbs for a short period?

Yes, I can

No, I cannot

You are required to keep footing in sea conditions

I am capable

No, I am not capable

This position requires standing. Note: This individual may be accomodated

Yes, I understand

No, I am not able to stand for random periods of time

Deckhand

Are you able to climb ladders? It's a job requirement.

Yes

You must be able to perform heavy lifting at times. Ae you capable of lifting 50 - 75lbs for a short period?

Yes, I can

No, I cannot

Engaging in strenuous pulling will be required of me at times.

Yes, I understand and am capabe

No, I am not capable

You are required to keep footing in sea conditions

I am capable

No, I am not capable

This position requires frequent standing.

Yes, I understand

No, I am not able to stand for periods of time

All individuals are required to meet the physical qualifications of a deckhand. Accommodation(s) cannot be granted.

Yes, I understand

No, I cannot fully commit to all requires

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (I) cancel further consideration of this application, or (II) immediately discharge me from the employer’s services, whenever it is discovered. If I am hired, I understand that I am free to resign at any time, with or without cause and/or prior notice, and the employer reserves the same right to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard. DO NOT SUBMIT THIS APPLICATION UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I have read all requirements and agree to the above.

I consent to have this website store my submitted information so they can respond to my inquiry

Application for Employment

Personal Information

Identification Record

In The Case of An Emergency, Notify:

Emergency Contact Address

Citizenship

Job Position

Previous Employment

References

Job Description & Physical Requirements

Boat Captain

Deckhand

Davant / Myrtle Grove

Passenger Landings

Belle Chasse

Poydras

Passenger Landings

Arabi

Passenger Landings

St. Rose (Ama)

Grandview (Lutcher)

Burnside (Mile 165)

(via Grandview Launch Station)

Darrow

(via Shamrock Sub-Station)

Davant /
Myrtle Grove