Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have a current Merchant Mariners Credential from the USCG? *

Yes

No

USCG Endorsements Held

Check all that apply

Master of Towing Vessels

Tankerman

Lifeboatman

AB Deckhand

Other

Do you have a TWIC Card? *

Yes

No

Important Notices: Please read the following: *

1. To receive proper consideration of this application, ALL questions on this application must be answered. 2. I understand that in answering any questions during the hiring process I should not disclose any disability I have. If I am offered a job, I will have to answer medical questions and take a physical examination. If I have a disability which requires accommodations, I should disclose it at that time along with written documentation from my medical provider. 3. I also understand that I will be required to take a test for controlled substances (drug/alcohol) at the time of my physical examination and at various other times without prior notice. A positive report from a drug or alcohol test, or refusal to submit to such test, may require a report of the incident to the U.S. Coast Guard and will be cause for termination of my employment. This policy may be implemented through periodic inspections of company equipment, lockers, job sites and personal property such as suitcases, bags, etc. by company or outside personnel. 4. In the event of employment, it will be my responsibility to purchase and wear safety shoes and wear such other safety equipment as required. 5. I understand that in the event I am employed, my employment and compensation may be terminated with or without cause, with or without notice, at any time, with or without any reason, at the option of either the company or me and that no representative of Norfolk Dredging Company, other than the president or chairman of the board, has any authority to enter into any agreement for employment for any specified period of time. 6. I understand that if employed and I undergo a physical examination and thereafter I fail to report for work or do not work for ten days, I agree to pay the cost of the physical examination, tests, laboratory work and other medical expenses including all costs and expenses incurred in collection, which if not paid by me, I authorize Norfolk Dredging Company to deduct from my wages. 7. If I am convicted of any offense involving illegal drugs or controlled substances, or if my driver’s license is revoked or suspended, I will immediately report this to Norfolk Dredging Company. 8. The facts set forth in my application for employment are true and complete. I understand that if employed, misrepresentations, omissions or false statements on this application shall be sufficient cause for dismissal. Norfolk Dredging Company is hereby authorized to make any investigation of my personal history and financial records through any agency of its choice including consumer and related reports, and to contact my previous employers to investigate any information in my background deemed pertinent. I agree to submit to substance (drug/alcohol) testing. I understand that the acceptance of this application does not indicate there are positions open and does not in any way obligate this Company. 9. If employed, I authorize any health care provider, hospital, physician or other person who has attended or examined me at any time to disclose when requested to do so by Norfolk Dredging Company or its representative(s), all information relating in any way to any illness or injury, medical history, consultation, prescription or treatment, and provide copies of all hospital, consultive and medical records. A photocopy of this authorization shall be as effective and valid as the original.

Please check here if you have read and agree to the notices above.