Moxy Marine Services
APPLICATION FOR EMPLOYMENT


Desired Position *
Date of Application *
Upload a Résumé if Available
How did you hear about the position?
 Friend 
 Newspaper 
 Online 
 Other 

PERSONAL INFORMATION

Last Name *
First Name *
Phone *

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Email *
Street Address *
City *
State *
Zip *
Are you eligible to work in the U.S.? *
 Yes 
 No 
Do you have a Social Security Number? *
 Yes 
 No 
Are you over 18? *
 Yes 
 No 
What type of employment do you desire?
 Full Time 
 Part Time 
 Summer 
Will you work overtime?
 Yes 
 No 
Desired amount of pay?
When can you start?
Do you have a drivers license? *
 Yes 
 No 
What state issued your drivers license?
When does your drivers license expire?
Describe any experience you have related to the position for which you are applying:

EDUCATION

High School

What High School did you attend?
How many years did you complete?
Did you graduate?
 Yes 
 No 
Did you receive a diploma?
 Yes 
 No 

College

What College did you attend?
How many years did you complete?
Did you graduate?
 Yes 
 No 
Did you receive a degree?
 Yes 
 No 
What type of degree?

Business/Trade/Technical

What Business/Trade/Technical School did you attend?
How many years did you complete?
Did you graduate?
 Yes 
 No 
Did you receive a diploma/degree?
 Yes 
 No 

CERTIFICATIONS AND LICENSES

List any professional organizations to which you belong:
List any certifications or licenses you hold:

WORK EXPERIENCE

Most recent place of employment:

Company Name
Address
Position/Job Title
Description of Duties:
Name of Your Supervisor
Phone Number of Your Supervisor

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Employment Start Date
Employment End Date
Pay Rate
Reason for Leaving

2nd most recent place of employment:

Company Name
Address
Position/Job Title
Description of Duties:
Name of Your Supervisor
Phone Number of Your Supervisor

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Employment Start Date
Employment End Date
Pay Rate
Reason for Leaving

3rd most recent place of employment:

Company Name
Address
Position/Job Title
Description of Duties:
Name of Your Supervisor
Phone Number of Your Supervisor

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Employment Start Date
Employment End Date
Pay Rate
Reason for Leaving

PROFESSIONAL REFERENCES

Name #1
Relation
Phone

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Name #2
Relation
Phone

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Name #3
Relation
Phone

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SPECIAL COMMENTS

Is there anything special you'd like to tell us about yourself?
Disclaimer *
 By checking here... 
I certify that answers given on this application (and accompanying resume) are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand that personnel forms do not constitute a contract for employment, and further, my employment is on an at-will basis and may be terminated, with or without notice, at the option of Moxy Marine Services, Inc. or myself. I understand that I am required to abide by all rules and regulations of the Company. I also understand that if I am hired, I will be required to provide proof of identity and authorization to work in the United States in accordance with the provisions of the Immigration Return and Control Act of 1986. The information in this Application is true, correct and complete. I understand and agree that I must successfully pass a pre-employment background check and drug screen prior to employment. I authorize Moxy Marine Services, Inc. to do a complete reference check on me including checking with my current and previous employers, educational records, verification of degrees obtained, GPA, DMV records and any other information deemed appropriate in consideration of my prospective employment with Moxy Marine Services, Inc.
Date *