JNB OPERATING, LLC.

JNB OPERATING, LLC.
4535 Hwy 308 Raceland, LA 70394
Date:

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Last
First
M.I.
Street Address

Mailing Address

Street Address Line 2

CityState

ZIP Code
Apartment/Unit
Mailing Address

Mailing Address

Street Address Line 2

CityState

ZIP Code
Apartment/Unit
Home Phone:
Email
example@example.com
Cell Phone
DOB

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Date Available:

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Social Security No.:
Height:
Weight
Position Applied for:
Emergency Contact
Address:
Phone:
Are you a citizen of the United States?

YESNO
If no, are you authorized to work in the U.S.?

YESNO
Have you ever worked for this company?

YESNO
Can you Swim?

YESNO
Have you ever been convicted of a felony?

YESNO
If yes, explain:
Would you be willing to submit to pre-employment and/or random drug testing?

YESNO
Would you be willing to have a physical examination and x-rays?

YESNO
Have you ever failed (tested positive) during a pre-employment or random drug and alcohol?

YESNO
If YES, Explain
Have you ever worked on an offshore vessel?

YESNO
If yes, how long?
Have you ever worked on an overseas vessel?

YESNO
If YES, how long & where
High School:
Address:
From:
To:
Did you graduate?

YESNO
Degree:
College:
Address:
From:
To:
Did you graduate?

YESNO
Degree:
Other:
Address:
From:
To:
Did you graduate?

YESNO
Degree:
Driver's License

YESNO
State
Driver's License Number
Driver's License Exp. Date

MonthDayYear
Date
USCG MMC

YESNO
USCG MMC Number
USCG MMC Exp. Date

MonthDayYear
Date
TWIC Card Exp. Date

MonthDayYear
Date
USCG license:
How many users on current license?
Additional License:
Additional License Number:
USCG License Exp Date:

MonthDayYear
Date
Please list three professional references.
Full Name:
Relationship:
Company:
Phone:
Full Name:
Relationship:
Company:
Phone:
Full Name:
Relationship:
Company:
Phone:
We require all employees to possess valid SafeGulf, 6 Edition Rigging and Water Survival Certificates or cards. If an offer of employment is made, any credential not in possession must be acquired in a timeframe suitable to Rec Marine Logistics. If it cannot be accomplished, employment may be terminated. By filling out this form, you certify that you either have the credential or are willing to take the training, free of charge, by a timeline set forth by the company safety officers.
TWIC - Did you complete??

YESNO
Where?
Expiration Date

MonthDayYear
Date
SafeGulf - Did you complete?

YESNO
Where?
Expiration Date

MonthDayYear
Date
6th Edition Rigging - Did you complete?

YESNO
Where?
Expiration Date

MonthDayYear
Date
Water Survival/HUET - Did you complete?

YESNO
Where?
Expiration Date

MonthDayYear
Date
First Aid/CPR - Did you complete?

YESNO
Where?
Expiration Date

MonthDayYear
Date
Firewatch - Did you complete?

YESNO
Where?
Expiration Date

MonthDayYear
Date
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From Date

MonthDayYear
Date
To Date

MonthDayYear
Date
Reason for Leaving:
May we contact your previous supervisor for a reference?

YESNO
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From Date

MonthDayYear
Date
To Date

MonthDayYear
Date
Reason for Leaving:
May we contact your previous supervisor for a reference?

YESNO
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From Date

MonthDayYear
Date
To Date

MonthDayYear
Date
Reason for Leaving:
May we contact your previous supervisor for a reference?

YESNO
Branch:
From Date

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To Date

MonthDayYear
Date
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
BY PLACING YOUR SIGNATURE BELOW, YOU CERTIFY THAT THE INFORMATION YOU HAVE PROVIDED ON THESE THREE PAGES IS COMPLETE AND TRUE TO THE BEST OF YOUR KNOWLEDGE AND YOU AUTHORIZE THIS COMPANY TO SOLICIT INFORMATION FROM YOUR PREVIOUS EMPLOYERS OR FROM OTHER PERSONS NAMED HEREON. THE FALSIFICATION OF DATA OR OMISSIONS OR MATERIAL FACTS WILL CONSTITUTE GROUNDS FOR DISMISSAL. FURTHER, PURSUANT TO SECTION 606 OF THE FAIR CREDIT REPORTING ACT, YOU ARE HEREBY ADVISED THAT THE COMPANY, OR ITS DESIGNEE, MAY, AT ITS OPTION, CAUSE TO BE PREPARED AN INVESTIGATIVE REPORT INCLUDING INFORMATION LIVING OBTAINED THROUGH PERSONAL INTERVIEWS WITH YOUR NEIGHBORS, FRIENDS, OR ASSOCIATES. YOU HAVE THE RIGHT, UPON WRITTEN REQUEST TO BE INFORMED OF THE NATURE AND SCOPE OF THIS INVESTIGATION, IF HIRED, YOU MAY BE REQUIRED TO SUBMIT DOCUMENTARY EVIDENCE OF BIRTH AND MILITARY SERVICE. IF YOU QUIT WITHIN 3 MONTHS OF SERVICE, YOUR PRE-EMPLOYMENT PHYSICAL WILL BE TAKEN OUT OF YOUR PAY.

PLEASE SIGN AND DATE THIS APPLICATION. WE APPRECIATE YOUR INTEREST IN OUR COMPANY AND THE TIME YOU HAVE TAKEN TO PREPARE THIS APPLICATION.
Signature:
Date:

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COMPANY USE ONLY-DO NOT WRITE BELOW THIS LINE
JOB DESCRIPTION-PHYSICAL REQUIREMENTS
1.Must climb ladders. 2.Must perform moderate lifting 3.Must be able to keep footing in sea conditions. 4.Position involves frequent standing.

1.Must climb ladders. 2.Must be able to keep footing in sea conditions. 3.Position involves frequent standing. 4.Must perform moderate lifting.

1.Must climb ladders. 2.Must perform heavy lifting 3.Is required to engage in strenuous pulling. 4.Must be able to keep footing in sea conditions. 5.Position involves frequent standing. 6.All individuals required to meet the physical qualifications of a deckhand may not be accommodated.

All above positions must meet a weight capacity of 100 pounds.

By signing below, you are acknowledging you have read and understand the above physical requirements.
Signature:
Date:

MonthDayYear
Date
Should be Empty:

JNB OPERATING, LLC.

4535 Hwy 308 Raceland, LA 70394

COMPANY USE ONLY-DO NOT WRITE BELOW THIS LINE

JOB DESCRIPTION-PHYSICAL REQUIREMENTS