Job Application

Personal Information

First Name:

Middle Initial:

Last Name:

Suffix:

Street Address:

City:

State

Zip:

Email:

Phone Number:

Alternative Phone
Number:

How many years have you lived at your present address?

If less than 5 years please give additional addresses

First Address

Address #1

City #1

State #1

Zip #1

Second Address

Address #2

City #2

State #2

Zip #2

Where can you be reached on short notice?

Where did you hear of Otto Candies, LLC?

Have you ever worked for Otto Candies, LLC?:

If yes, please list work time. I worked
for Otto Candies, LLC from (mm/dd/yyyy) to (mm/dd/yyyy)

Reason for Leaving:

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

If so, please explain:

Do you have any objection to working foreign?

Do you have relatives working for Otto Candies, LLC?
If so, please list:

Do you have a current Drivers
License?:

DL #:
State:

Do you have an automobile:
License Plate #:

Estimated drive time from your home to our office:

Do you have a valid passport?

Passport #

Emergency Contact Information

Emergency Contact Name:
Relationship:

Emergency Contact Address:

Emergency Contact Phone Number:

Licenses

Category:
Exp. Date:

Category:
Exp. Date:

Category:
Exp. Date:

Category:
Exp. Date:

Category:
Exp. Date:

Category:
Exp. Date:

Mariner Reference Number

Exp. Date:

Capacity & Limitations of USCG Credential

STCW: Yes No

Nautical Institute DP Operator:
Limited
Unlimited
N/A

Job Preferences

Schedule First Choice:

Schedule Second Choice:

Position or type of work requested:

Second Choice:

Employment History

Education

Elementary School (Grades 1-8)

High School (Grades 9-12)

College

Other

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

Basic Safety Training

Dynamic Position Induction

Dynamic Position Advanced

Dynamic Position Operator

GMDSS

ARPA

VSO

Military Record

Record #1

Record #2

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