3900 Railway Avenue, Everett Washington 98201 Telephone (425) 742-8609 Fax: (425) 742-8699  


APPLICATION FOR AT WILL EMPLOYMENT
(By Deep Sea Fisheries, or other independent employer)

EQUAL EMPLOYMENT OPPORTUNITY POLICY. The policy of Deep Sea Fisheries, Inc. (and all other independent “Employers” for whom Deep Sea Fisheries, Inc. provides employment and personnel services) is to seek and employ the best qualified personnel and to provide equal opportunity for the advancement of employees, including upgrading, promotion and training and to administer these activities in a manner that does not discriminate against any person because of race, color, religion, age, sex, marital status, national origin, or physical or mental handicap or disability.
DATE OF APPLICATION SOCIAL SECURITY NUMBER DATE AVAILABLE
LAST NAME FIRST NAME INITIAL
STREET ADDRESS CITY STATE ZIP
RESIDENCE PHONE      (        ) ALTERNATE PHONE (        )
POSITION APPLIED FOR
1. 2. 3.
ARE YOU WILLING TO SUBMIT TO DRUG TESTS OF URINE, BLOOD, SALIVA AND BREATH?  YES  NO
ARE YOU 18 YEARS OR OLDER? YES  NO 
HAVE YOU EVER WORKED IN ALASKA?  YES  NO
HAVE YOU EVER WORKED ON A VESSEL? 
VESSEL NAME
WHEN?
WHERE?
YES  NO

 

 
WHO REFERRED YOU TO DEEP SEA FISHERIES? HAVE YOU EVER WORKED FOR DEEP SEA FISHERIES IN THE PAST? IF SO,
NAME:
NEWSPAPER:
OTHER:
WHERE?
WHEN?
POSITION?
EDUCATION 
(NAME AND LOCATION OF SCHOOL)		 FIELD OF STUDY YEARS COMPLETED ATTENDED
FROM/TO		 DEGREE/DIPLOMA
HIGH SCHOOL        
COLLEGE        
OTHER        
QUALIFICATIONS Please list any licenses, certificates, training, or specialized experience you feel relates to the position (s) applied for that would help you perform the work, such as schools, vocational, technical programs, military training, hobbies, work experience etc. Please indicate your seafood handling skills and experience. 
 
 
CRIMINAL CONVICTIONS (Crimination of a crime is not an automatic bar to employment. factors such as age of the offense, the seriousness and nature of the violation and rehabilitation will be considered.
Have you ever been convicted of a crime other than a traffic violation in the past 7 years?  YES  NO
If yes, please explain:
 
PERSONAL ABILITIES
ARE THERE ANY DAYS YOU ARE NOT AVAILABLE TO WORK, MONDAY THROUGH SUNDAY? YES  NO
ARE THERE ANY HOURS OR SHIFTS YOU ARE NOT AVAILABLE TO WORK IN A 24 HOUR DAY? YES  NO
DO YOU HAVE THE ABILITY TO PERFORM THE ESSENTIAL FUNCTIONS OF THE WORK NORMALLY INVOLVED IN THE POSITIONS (S) FOR WHICH YOU ARE APPLYING? YES  NO
If no, please explain:
 
EMPLOYMENT HISTORY
PRESENT OR LAST EMPLOYER (Company Name) MAY WE CONTACT? ___________  PHONE:(           )
ADDRESS
JOB DUTIES
HIRE DATE JOB TITLE START PAY
DATE LEFT SUPERVISOR FINAL PAY
REASON FOR LEAVING
PREVIOUS EMPLOYER (Company Name)  PHONE:(           )
ADDRESS
JOB DUTIES
HIRE DATE JOB TITLE START PAY
DATE LEFT SUPERVISOR FINAL PAY
REASON FOR LEAVING
PREVIOUS EMPLOYER (Company Name)  PHONE:(           )
ADDRESS
JOB DUTIES
HIRE DATE JOB TITLE START PAY
DATE LEFT SUPERVISOR FINAL PAY
REASON FOR LEAVING
PREVIOUS EMPLOYER (Company Name)  PHONE:(           )
ADDRESS
JOB DUTIES
HIRE DATE JOB TITLE START PAY
DATE LEFT SUPERVISOR FINAL PAY
REASON FOR LEAVING
1. I authorize the investigation of all matters which Deep Sea Fisheries, Inc. (and other Employer) deems relevant to my qualifications for employment, including all statements made in this application and in any attachments and supporting documents. I authorize you to request and receive such information and I release from all liability any persons (such as former supervisors or employers) supplying it. I also release you from liability which might result from making the investigations. 

2. I certify that the facts and information in this application and in any attachments or supporting documents are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation or omission, as well as any misleading statement or omission, may result in denial of employment or immediate termination, regardless of when or how discovered. 

3. I agree to conform to all existing and future Deep Sea Fisheries, Inc. (and other Employer) policies, work rules and duties and I understand that such policies and rules may be changed, interpreted, withdrawn, or added to as the employer deems appropriate. I also understand that Deep Sea Fisheries, Inc. (and other Employer) reserves the right to change wages, days and hours of work and working conditions as deemed necessary

4. I understand that after conditional offer of employment (and my acceptance of the offer) I may be required to submit to medical, physical and mental health examinations, including tests for the presence of alcohol and other drugs, tests of urine, blood, saliva and breath, before, during and after actual employment. I agree to such testing at the Employer’s expense. I authorize release of the results to Deep Sea Fisheries, Inc. (and other Employer) and use of the results to evaluate whether I have the physical and mental ability, with or without reasonable accommodation, to perform the essential functions of the employment positing for which I applied, and to evaluate whether I have any other condition that is not protected by the applied, and to evaluate whether I have any other condition that is not protected by the Americans with Disabilities Act or other law.

5. I release Deep Sea Fisheries, Inc. (and other employer) from any and all liability incident to the testing or use of the results for this evaluation.
I understand this application is for an at will employment contract. This application does not constitute an employment contract.  I understand that if I am offered and accept a position, I may resign or be terminated, with or without cause of notice at any time.

Applicant's Signature Date
INTERNAL USE ONLY
HIREDYES  NO  POSITION:
PAY RATE: VESSEL:
AIR FARE: DT SC DD
INTERVIEWED       M    T   W   TH      F BY:
FORM 110      REVISED  10/23/2002