Application

First Name

Middle Initial

Last Name

Suffix

Street Address

City

State
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip

Email

Phone Number

Alternative Phone Number

How many years have you lived at your present adress?

123456789101112131415 or 15+

If less than 5 years please give additional addresses

Address #1

Address #2

Where can you be reached on short notice?

Where did you hear of Otto Candies LLC?

Have you ever worked for Otto Candies?:
NoYes

If yes, please list work time. I worked for
Otto Candies

from  to  mm/dd/yyyy

Reason for Leaving:

Are you 18 years old or older?
NoYes
Have you ever been convicted of a felony?:
NoYes

If so, please explain:

Do you have any objection to working foreign?

Do you have relatives working for Otto Candies?
NoYes
Please list:

Do you have a current Drivers License?:SelectNoYes
DL #:

State:

Do you have an automobile:
NoYes
License plate #:

Estimated drive time from your home to our
office:

Do you have a valid passport?
NoYes

Passport #

Emergency Contact Information

Emergency Contact Name:

Relationship:

Emergency Contact Address:

Emergency Contact Phone Number:

Category: – Select One –Master/CaptainMateLicensed EngineerQMEDABLE SeamanOrdinary Seaman  Exp. Date:
Category: – Select One –Master/CaptainMateLicensed EngineerQMEDABLE SeamanOrdinary Seaman  Exp. Date:
Category: – Select One –Master/CaptainMateLicensed EngineerQMEDABLE SeamanOrdinary Seaman  Exp. Date:
Category: – Select One –Master/CaptainMateLicensed EngineerQMEDABLE SeamanOrdinary Seaman  Exp. Date:
Category: – Select One –Master/CaptainMateLicensed EngineerQMEDABLE SeamanOrdinary Seaman  Exp. Date:
Category: – Select One –Master/CaptainMateLicensed EngineerQMEDABLE SeamanOrdinary Seaman  Exp. Date:

“Z” Card Number:

Exp. Date:

Type (OS-AB-QMED):

STCW ’95: Yes   No 

Nautical Institute DP Operator:
 Limited
 Unlimited
 N/A

Job Preferences

Schedule First Choice:

56/2828/2828/1414/14

Schedule Second Choice:

56/2828/2828/1414/14

Position or type of work requested:

CAPTMATEChief Engr1st Asst EngrOILERA/BO/SO/S Crane Operator

Second Choice:

CAPTMATEChief Engr1st Asst EngrOILERA/BO/SO/S Crane Operator

Elementary School (Grades 1-8)

Highest Grade Completed:  87654321

Name of School:

High School (Grades 9-12)

Highest Grade Completed:  1211109

Name of School:

College

# of years attended:

Name of School:

Major:

Completed Degree?:  NoYes

Other

# of years attended:

Name of School:

Major/Specialty:

Completed Degree or certification?:NoYes

Give below a list of all STCW or Marine related training which is relevant to performing the job for which you are applying

Military Record

NoYes, I have reviewed this application, and it is accurate to the best of my knowledge.