PROGRESSIVE MARINE SERVICE, LLC

Transcription

1 P.O. BOX 812 NEW CANEY, TEXAS PHONE FAX ProgressiveMarineService.com APPLICATION FOR EMPLOYMENT POSITION APPLYING FOR DATE NAME / / SALARY DESIRED LAST FIRST MI ADDRESS STREET CITY STATE ZIP PHONE ALT. PHONE SOCIAL SECURITY NUMBER MARITAL STATUS: S M D W SPOUSE S NAME / CONTACT NUMBER YEAR AND MAKE OF VEHICLE ARE YOU CURRENTLY EMPLOYED YES NO GRADUATED HIGH SCHOOL YEAR GRADUATED GED/YR COLLEGE LOCATION DATES / OTHER EDUCATION PLACE OF BIRTH US CITIZEN YES NO MILITARY (BRANCH) HIGHEST RANK TYPE OF DISCHARGE YEARS ENLISTED / IN RESERVES YES NO DO YOU HAVE A DD-214 HAVE YOU BEEN CONVICTED OF A FELONY IN THE LAST FIVE YEARS YES NO ARE YOU TAKING ANY MEDICATIONS YES NO IF YES, WHAT CERTIFICATIONS ATTACHED: TWIC MMC SAFE GULF HUET RIG PASSPORT CRANE SEMS DP SO THAT WE DO NOT DUPLICATE YOUR EFFORTS, PLEASE LIST ANY COMPANIES YOU HAVE RECENTLEY APPLIED TO WITHIN THE MARITIME INDUSTRY HOW DID YOU LEARN ABOUT PROGRESSIVE MARINE SERVICE, LLC Bob Johnson

2 LAST NAME EMPLOYMENT HISTORY - PLEASE BE AS ACCURATE AS POSSIBLE EMPLOYER S NAME PH POSITION ADDRESS/CITY EMPLOYED FROM / TO / SALARY STARTING ENDING REASON FOR LEAVING EMPLOYER S NAME PH POSITION ADDRESS/CITY EMPLOYED FROM / TO / SALARY STARTING ENDING REASON FOR LEAVING EMPLOYER S NAME PH POSITION ADDRESS/CITY EMPLOYED FROM / TO / SALARY STARTING ENDING REASON FOR LEAVING EMPLOYER S NAME PH POSITION ADDRESS/CITY EMPLOYED FROM / TO / SALARY STARTING ENDING REASON FOR LEAVING REFERENCES (OTHER THAN RELATIVES AND FORMER EMPLOYERS) NAME PHONE ( NAME PHONE ( NAME PHONE ( ) OCCUPATION ) OCCUPATION ) OCCUPATION

3 PLEASE CHECK OFF YOUR EXPERIENCE SKILLS: DECK PERSONNEL LAST NAME SUPPLY BOATS INLAND CREW BOAT UTILITY BOATS DIVE BOAT HARBOR TUGS SEISMIC VESSEL OFFSHORE CREW TANKERS OFFSHORE TUGS PUSH/TOW BOAT 4 PT ANCHOR HANDLING FISHING FREIGHTERS LIGHTERING OTHERS NOT LISTED SINGLE SCREW DOUBLE TRIPLE QUAD GEOGRAPHICAL AREAS OF WORK DYNAMIC POSITIONING SPECIAL TRAINING / SCHOOLS TANKERMAN: WHAT HAVE YOU PUMPED? ENDORSEMENTS YOU HOLD? ENGINE PERSONNEL HYDRAULICS A/C REF. ELECTRICAL FREON CHILL WATER PUMPING MUD WINCHES AMMONIA OTHER EXP DO YOU HAVE YOU OWN TOOLS? VALUE $ HIGHEST HORSEPOWER ENGINE EXPERIENCE: (LIST SERIES) EMDS DETROITS FAIRBANKS CATS NOHAB ALCOS CUMMINS MANN PILSTICK OTHERS SPECIAL TRAINING / SCHOOLS COOKS RIGS SUPPLY BOATS CAMPS BARGES SEISMIC BOATS SHIPS OTHER VESSELS DO YOU HAVE YOUR OWN COOKING UTENSILS? VALUE CAN YOU BAKE FROM SCRATCH, IF YES, WHAT? MAXIMUM PEOPLE YOU HAVE COOKED FOR: SPECIAL DISHES CAN YOU ORDER GROCERIES SPECIAL TRAINING/SCHOOLS

4 PAYROLL CHECK INSTRUCTIONS *************************************************************************************** IF YOU WOULD LIKE YOUR CHECK HELD AT OUR OFFICE IF YOU WOULD LIKE US TO MAIL YOUR CHECKS TO YOUR HOME ADDRESS FOR CHECKS TO BE MAILED TO IF YOU WOULD LIKE YOU CHECKS DIRECT DEPOSITED TO YOUR BANK, PLEASE FILL OUT COMPLETELY BELOW: AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT (ACH) I HEREBY AUTHORIZE PROGRESSIVE MARINE SERVICE, LLC TO INITIATE CREDIT ENTRIES AND INITIATE, IF NECESSARY DEBIT AND ADJUSTMENTS FOR ANY CREDIT ENTRIES IN ERROR TO MY CHECKING/SAVINGS ACCOUNT INDICATED BELOW, HEREINAFTER CALLED DEPOSITORY, TO CREDIT AND OR DEBIT THE SAME SUCH ACCOUNT. DEPOSITORY: (YOUR BANK INFORMATION) BANK NAME CITY STATE BANK PHONE ABA NO /TRANSIT ACCOUNT NUMBER THIS AUTHORITY IS TO REMAIN IN FULL FORCE AND EFFECT UNTIL PROGRESSIVE MARINE SERVICE, LLC HAS RECEIVED WRITTEN NOTIFICATION FROM ME OF ITS TERMINATION IN SUCH TIME AND IN SUCH MANNER AS TO AFFORD PROGRESSIVE MARINE SERVICE, LLC AND DEPOSITORY A REASONABLE OPPORTUNITY TO ACT ON IT. YOU MUST ATTACH A VOIDED CHECK OR VOIDED SAVINGS DEPOSIT SLIP BELOW I understand that Progressive Marine will not release any information regarding my payroll to anyone else unless I give written permission. NAME SSN DATE SIGNATURE ADDRESS FOR CHECK STUBS, STATEMENTS, ALL PAPERWORK NAME ADDRESS CITY STATE ZIP

5 CONTRACT OF EMPLOYMENT PLACEMENT SERVICES WITH POWER OF ATTORNEY This contract is entered into by and between (full legal name), an individual, hereinafter referred to as Applicant and Progressive Marine Service, LLC a company formed and existing under the laws of the State of Texas, hereinafter referred to as Progressive Marine. Progressive Marine and affiliates shall make good faith efforts and reasonable attempts to obtain employment opportunities for the Applicant. However, Progressive Marine cannot warrant nor represent any guarantee of obtaining employment opportunities for Applicant. On the condition the Applicant accepts any part-time, seasonal, temporary, or long-term permanent employment with any Employer that Progressive Marine has either referred Applicant to such Employer or referred such Employer to Applicant, the Applicant agrees to pay Progressive Marine for services rendered at a fee rate of twenty percent (20%) of the Applicant s gross earnings for the first 60 worked days, regardless if the days worked were consecutive or intermittent. Applicant will authorize the Employer to Forward Applicant s paycheck to Progressive Marine. Applicant will authorize Progressive Marine to receive, endorse, and deposit Applicant s paycheck. Progressive Marine will accept, and deposit any of the Applicant s paycheck that is received. Progressive Marine shall deduct twenty-percent (20%) of gross wages from the Applicant s Net paycheck as partial payment for services rendered. Progress Marine will then issue a check for the remaining amount payable to Applicant. These deductions will continue in force until twenty percent (20%) of the gross for 60 worked days has been paid to Progressive Marine. Once Progressive Marine has been paid in full then Progressive Marine will no longer accept, endorse, or deposit Applicant s Paycheck. If Progressive Marine receives Applicant s paycheck after Progressive Marine has been paid in full, then Progressive Marine will forward such complete paycheck directly to Applicant s last known address. If employment ends for any reason before this contract has been satisfied in its entirety, the remainder of fee will not be owed by Applicant. However, if Applicant returns to the Employer referred to by Progressive Marine within one (1) year from the last day Applicant worked for the Employer referred under this contract, the balance of Progressive Marine s interest of twenty percent (20%) of the Applicant s gross earnings from the initial sixty (60) days Applicant was employed or worked is due and this contract shall remain in effect. Should any part of this contract be rendered or declared invalid by a court of competent jurisdiction, such invalidation of such part or portion of this contract should not invalidate the remaining portions thereof, and the remaining portions shall remain in full force and effect and the invalidated, illegal or unenforceable term or provision shall be deemed replaced with a term or provision that is valid and enforceable and that comes closest to expressing the original intention of the parties to this contract. Applicant s initials Page 1 of 2

6 I, the undersigned and named affiant, state and affirm that I understand fully that this agreement is a Power of Attorney authorizing Progressive Marine Service, LLC to endorse and deduct twenty-percent (20%) of gross wages from my payroll check or other compensation from the Employer that I was referred to by Progressive Marine Service, LLC and Progressive Marine Service, LLC will remit the remainder of my payroll check or other compensation to me within 24 hours of receiving the paycheck. I also understand that this Power Of Attorney and the deduction that this contract authorizes is a security interest for Progressive Marine Service, LLC to ensure payment of the services it rendered on my behalf and for my benefit. It is agreed that I, the Applicant, shall at all times have the right to refuse any employment that was referred to me by Progressive Marine Service, LLC I further understand that expenses I incur to travel to and from any job interviews are my responsibility and I agree to release Progressive Marine Service, LLC from any and all damages and liabilities and responsibilities connected with my job interviews. I also authorize the Employer referred to me to Progressive Marine Service, LLC to mail all paychecks to Progressive Marine Service, LLC at P.O. Box 812, New Caney, Texas until my contract has been fulfilled in its entirety. I also understand that upon completion of this contract/agreement that Progressive Marine Service, LLC will mail a release form to my Employer releasing me from any and all obligations in this agreement and the Employer shall then forward all paychecks to me directly. Affiant/Applicant Signature Social Security Number Date Printed Full Legal Name The above named affiant swore, affirmed, and subscribed to this contract before me on this day of, 20 Signature of Notary Public Printed Name of Notary Applicant s Initials Page 2 of 2