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Name *

First

Middle

Last

Are you at least 18 or older? *

Phone Number

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Referred By:

Preferred Compensation

Position Desired

For Crew Members: Crew Rotation Desired

Date Available to Start Work

For Shore-Based Employees: Indicate Desired Job Status

# Hours Available

Highest Level of Education Completed

Level Of School

School Name

City

State

Did you Graduate?

Graduation Date

Degree Received

Major

Single Line Text

Major Name

Name of Employer

Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Title

Duties/Experience

Start Date

Are You Still Currently Employed Here?

End Date

What is your means of transportation to work?

Have you had any motor vehicle accidents or had your license suspended in the past five (5) years?

How Many Occurences?

Selected Value: 1

Please describe the nature of the vehicle or license suspension occurence

Have you had any moving violations during the past (3) years?

How Many Moving Violations Have You had during the past three (3) years?

Selected Value: 1

Please describe the nature of each moving violation

Are you a veteran of the United States Military?

Did you receive an Honorable Discharge?

Discharge Date

If hired, can you provide proof or your legal right to work in the United States?

Have you reviewed essential functions and duties of the job for which you are applying?

Are you able to perform the essential functions and duties of the job which you are applying with or without reasonable accommodation?

Have you ever failed or refused a Drug or Alcohol Test, job-related or not?

If so, provide the date and entity that required the test:

Have you EVER been convicted of any criminal offense? (including, but not limited to DUI, DWI, felony, or misdemeanor, whether expunged or not)

Conviction will not necessarily disqualify an applicant from employment. Each instance and explanation will be considered in relation to the position for which you are applying.

Provide a complete explanation for each offense

For each offense, include the year of the offense, what the offense was, and sentence received for the offense.

Have you ever been a party to a lawsuit or civil action?

Parties to Lawsuit

Court or Parish/County Lawsuit was filed

Brief Explanation of Claims Asserted in Lawsuit

Typing

Microsoft Word

Microsoft Excel

Microsoft Outlook

Databases

Office Accounting/Billing Software

Other

Reference Name 1

First

Last

Relationship

Years Associated

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference Name 2

First

Last

Relationship

Years Associated

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference Name 3

First

Last

Relationship

Address

Address Line 1

Address Line 2

City

State

Zip Code

Years Associated

Please Indicate Any of the Following Credentials You Have:

Transportation Worker ID Credential (TWIC)
SafeGulf Card
Merchant Mariners Credentials (MMC)

Please Indicate any of the following STCW Endorsements You Currently Have:

GMDSS
ARPA
Bridge Resource Management
Medical Care Provider
VSO
DP
RFPNW
RFPEW
Radio License
FCC
Other

If Other, Please Specify:

Mechanical

Eletrical

Welding and/or Fitting

Carpentry or Plumbing

Other Relevant Skills

Please Provide Information Regarding Your Mechanical Experience

Please Provide Information Regarding Your Electrical Experience

Please Provide Information Regarding Your Welding/Fitting Experience

Please Provide Information Regarding Your Carpentry or Plumbing

Please Provide Information Regarding Any Other Relevant Skills

Exact Wording Including Endorsements and Notations

Amount of Seatime Currently Held

Tonnage Limitations

Single Line Text

Issue Date

Issue Location

Expiration Date

Do You Have Another Certification to Add?

Documentation or Certifications Received

Endorsements, Notations and Limitations

Name of Issuing Entity

Issue Date

Expiration Date

Have you had any accidents operating any vessel in the last five (5) years?

Please Provide Explanation for each Occurrence

Have you had any suspension or revocation of a marine license you have held in the last five (5) years?

Please Provide Explanation for each Occurrence

Would You Like to Add Another?

Agreement and Submission *

I certify that all information in this application is accurate and complete to the best of my knowledge. I understand that providing misleading or false information is grounds for refusal to hire, withdrawal of an offer, or immediate termination of employment if I am hired. I authorize Harvey Gulf International Marine, LLC to verify any or all of the information listed in this application and consent to a credit, driving and/or criminal history background check. I also authorize Harvey Gulf to contact references, employers and/or educational institutions listed in this application. I release Harvey Gulf and its representatives from all claims damages and liability arising in connection with seeking, gathering and using such information and all other persons, corporations or organizations for releasing such information. I understand that neither the acceptance of this application nor the subsequent entry into any type of employment relationship with Harvey Gulf creates an actual or implied contract of employment. I understand that, if an offer of employment is extended, it will be conditioned upon: 1.) my taking and passing a drug test; and 2.) my undergoing a medical examination and the examination not revealing any physical condition that prevents my performing the essential duties of the position offered to me with or without reasonable accommodation. I further understand that, if I accept employment with Harvey Gulf, my employment will be on an “at will” basis. This means that either Harvey Gulf or I have the right to terminate the employment relationship at any time, with or without notice, for any reason, with or without cause.

HARVEY GULF INTERNATIONAL MARINE

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