10306 E Lick Fork Road Celestine, IN 47521 (812)678-3313 rebecca@hoosierhillsmarina.com
Name
Address
Email
Contact Number
What position are you applying for?
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Dock Hands-Seasonal
Clerk/Reservations-Seasonal
Groundskeeping-Seasonal
Restaurant/Bar-Seasonal
Maintenance-Full Time/Part Time
Marine Mechanic-Full Time/Part Time
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Desired Salary
If you are under 18 years of age, can you provide a work permit?
Yes
No
How many Hours per week could you work?
Do you have a valid driver license?
Yes
No
Do you have reliable transportation?
Yes
No
Have you ever worked for this company before?
Yes
No
If yes, When?
Are you legally allowed to work in the United States?
Yes
No
Do you have a Indiana Servers License?
Yes
No
Can you work weekends and Holidays?
Yes
No
Can you work Mondays and Fridays?
Yes
No
Do you have travel plans between May 1st and September 7th? If so, please explain and list dates:
Education
School Name - Location - Years Attended - Degree Received - Major
School Name - Location - Years Attended - Degree Received - Major
Other training, Certification, or Licenses held:
Summarize any special skills or qualifications (computer skills, mechanical skills, etc.)
Active Military Status National Guard or Reserve:
Rank at Discharge:
Type of Discharge:
Employment
Employer - City - State - Supervisor - Phone Number
Start Date
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End Date
MM
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YYYY
Position - Pay Rate
May we contact?
Yes
No
Duties Performed:
Reason for Leaving:
Employer - City - State - Supervisor - Phone Number
Start Date
MM
/
YYYY
End Date
MM
/
YYYY
Position - Pay Rate
May we contact?
Yes
No
Duties Performed:
Reason for Leaving:
Employer - City - State - Supervisor - Phone Number
Start Date
MM
/
YYYY
End Date
MM
/
YYYY
Position - Pay Rate
May we contact?
Yes
No
Duties Performed:
Reason for Leaving:
References
must be work related and/or school principal, teacher, guidance counselor, coach, etc.
Reference #1
Email
Phone
Affiliation
Reference #2
Email
Phone
Affiliation
Reference #3
Email
Phone
Affiliation
Record of Conviction
A conviction will not necessarily automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness, and nature of the crime, and rehabilitation will be considered
During the last 10 years, have you ever been convicted of a crime other than minor traffic offenses?
Yes
No
If Yes, explain:
Acknowledgement and Authorization
I certify that all answers given herein are true and complete to the best of my knowledge:
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Yes
No
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I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision:
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Yes
No
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In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge:
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Yes
No
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In consideration of my employment, I agree to adhere to all existing & future instructions, rules & policies:
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Yes
No
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Signature
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Date
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Verification
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