| Today's Date |
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| Last Name, First Name, MI |
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| Social Security No. |
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| Present Mailing Address |
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| Phone No. |
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| Permanent Mailing Address |
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| Permanent Phone No. |
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| Email Address |
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| What Dates Are You Available For Work? |
Beginning
Ending |
| Position(s) Applied For: |
1st choice |
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| 2nd choice |
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State Or Federal Laws May Impose A
Minimum Age Requirement.
Are You Over: 14
15 16
17 18
19 21
Date of Birth
Male
Female
Race |
How Did You Learn About Us?
Employee Job Fair (Where)
Advertisement Internet (Site)
Walk-In School
Other (Explain) |
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| Are You Currently Employed? |
Yes
No |
| May We Contact Your Present Employer? |
Yes
No |
| Do You Have a Current And Valid
Drivers License? |
Yes
No |
| If Yes, What State, License No., Exp.
Date |
|
| Do You Have a Commercial Drivers
License (Cdl)? |
Yes
No |
| If Yes, What State, License No., Exp.
Date |
|
Do You Have a USCG License(s) and/or
Endorsement(s)?
If Yes, Please Explain: |
Yes
No
|
| Are You Legally Eligible for
Employment in the Us? (Proof Of Citizenship Or Immigration Status
Will Be Required Upon Employment.) |
Yes
No |
Have You Been Convicted Of A Felony
Within The Past Five Years?
(A Conviction Does Not Automatically Disqualify Applicant From
Employment, All Circumstances Will Be Considered.) |
Yes
No |
If You Are Applying For A Position
Which Would Require That You Operate Vehicles Or Watercraft, Have
You Been:
Subject To License Suspension, Revocation, Or Conviction For A
Reckless Driving Offense, Driving Under Influence Of Alcohol Or
Drugs, Or Other Serious Driving Offense Within The Past Five
Years? (A Conviction Does Not Automatically Disqualify Applicant
From Employment, All Circumstances Will Be Considered.) |
Yes
No |
Alaskan Hire Is Given Preference.
Are You An Alaskan? |
Yes
No |
| Indicate Any Language(s)
Other Than English You Can Speak, Read, And/Or Write |
Language 1
Fluent
Good Fair
Speak
Read Write |
Language 2
Fluent
Good Fair
Speak
Read Write |
Education:
School Name Address (City & State) Course Of Study Degree/Year
Completed
College(s), Graduate/Certification, Other (Specify) |
|
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High School Name & Address
Completed? |
Yes
No |
Employment History Start With Your Present Or Last Job |
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References Please Provide Us With A Minimum Of Three (3)
Work References |
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References Please Provide Us With A Minimum Of Three (3)
Personal References |
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Any felonies in the past?
Yes
No
Can you lift 60 to 80 pounds?
Yes
No
Can you stand on your feet for long periods if necessary?
Yes
No
Do you have any Physical Problems?
Yes
No
If YES to any of the above please elaborate:
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Use this space for any additional
comments:
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If you would like to send a resume
please email it to
millerslanding@alaska.com and mention you have filled out
this form. Thanks.
|
I understand that some positions may
be required to submit to pre-employment and random drug testing.
I acknowledge that employment at Miller’s Landing is at will,
which means that either I or Miller’s Landing can terminate the
employment relationship at any time, with or without prior notice,
or for any reason not prohibited by law.
I certify that the foregoing is true and accurate to the best of
my knowledge. I understand that if I have misrepresented or
omitted any facts or relevant information, and am subsequently
hired, I may be discharged from my job. I authorize release of all
information pertaining to me from the records of educational
institutions, branches of the U.S. military and reserves, state or
federal law enforcement agencies, and present and past employers
to Miller’s Landing or its designated representative. |
