preliminary application
for employment


Date:
Name: (Last)
Name: (First)
Name: (Middle)
E-mail

Current Address:
City:
State:
Zip Code:
Telephone:
Social Security No:
Are you 18 years or older?	Yes No
Have you ever been convicted of a crime?	Yes No

EMPLOYMENT DESIRED:
Position:
Availability date to start:
Salary Desired:
Are you employed now? (Andrie Inc. Prohibits Dual Employment)	Yes No
If yes, may we inquire of your present employer?	Yes No
Have you ever applied to this company before?	Yes No
Have you ever worked for this company before?	Yes No

List any friends or relatives working for us or have worked for us:

What current Coast Guard licenses do you hold?

What endorsements?

Do you have a Seaman's Card?	Yes No
Expiration date:

Do you have a current drivers license?	Yes No

Equipment & vessels, description & h.p. operated or worked on:

Do you have any skills, qualifications, certifications, welding, CPR, first aid, or experiences which you feel would be beneficial to Andrie Inc?

Number of days lost due to illness within the past two years?
To send the form, click submit.

All responses are kept on file for no more than 60 days.
Thank You For Applying! Andrie Inc. Is An Equal Opportunity Employer Subject to Execution of Standard Uniform Company Employment Documents

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