UniSea Group Companies

APPLICATION FOR EMPLOYMENT

Please complete in full.

An Equal Opportunity Employer

APPLICANT INFORMATION
Position Applying For

Date

Social Sec #
First Name

Last Name

M.I.

Other names worked under

Email Address

Address
City

Zip Code

State

Telephone

Cell or Message Phone

How did you learn of this opening?

Date of Birth (if under 21)

Are you over 18 years old?

Referring Employee Name/EE#

No

Yes

Acceptable starting salary

Date available for work

Are you eligible to work in the United States?

Yes

No

Were you previously employed by any UniSea Group Company?

(If hired, proof of employment authorization will be required)

No

Yes

Year(s)

If yes, Employee ID# (if known)

(UniSea, Inc., UniSea Foods, Dutch Harbor Seafoods, Cascade Seafoods)

List relatives currently employed by UniSea Group Company:

(Name)

Are you able to perform the essential job functions of the position for which you are applying?

(Relationship)

Yes

No

EDUCATION AND TRAINING

Name of School

Location

From Year To Year

Did you
Graduate?

Major

Degree Obtained

No Selection
No Selection
No Selection

Do you plan to return to school?

Office Use Only

Yes

No

If yes, when?

Hours attending

ADDITIONAL SKILLS/ABILITIES/KNOWLEDGE

List other job-related special training, certifications, skills, etc. that should be considered for placement. (Please

Entered by

exclude those that indicate age, race, color, national origin, religion or disability.)

Entered @ AP Date
Letter/Date
@ AP Updates

Interviewer
Interview Date

UniSea Group companies may require as a condition of employment all employees to agree to provide urine, saliva or other
samples to be used for analysis of drug use under circumstances of pre-employement or as deemed necessary by company
management. In addition, all employees covered by the United States Coast Guard Regulations will be required to submit
urinalysis under circumstances set out in the U.S.C.G. Regulations relating to serious marine accidents and testing programs.
to
UniSea, Inc. ~ 15400 NE 90th Street ~ P.O. Box 97019 ~ Redmond, WA 98073-9719 ~ Employment Line: (425) 861-5330

EMPLOYMENT HISTORY
List past and present employment, beginning with most recent. Please include part-time, summer and volunteer positions, and relevant U.S.
military experience. Please complete in full.
Social Sec #

A resume does not substitute for completing this section.

Yes

May we contact your present employer?

Employed By:

Employed From

No
Starting Position

Starting Salary
F.T

Address

City

State

Zip Code Employed To

Ending Salary

Ending Position
F.T.

Supervisor (Name & Title)

P.T.
P.T.

Phone Number (include area code)

May we contact?

No Selection
Responsibilities and Accomplishments
Reason for Leaving

Employed By:
Address

Employed From
City

State

Zip Code Employed To

Starting Position

Starting Salary
F.T

P.T.

F.T.

P.T.

Ending Salary

Ending Position

Phone Number (include area code)

Supervisor (Name & Title)

May we contact?

No Selection
Responsibilities and Accomplishments
Reason for Leaving

Employed By:
Address

Employed From
City

State

Zip Code Employed To

Supervisor (Name & Title)

Starting Position

Starting Salary
F.T

P.T.

F.T.

P.T.

Ending Salary

Ending Position

Phone Number (include area code)

May we contact?

No Selection
Responsibilities and Accomplishments
Reason for Leaving

Employed By:
Address

Employed From
City

State

Zip Code Employed To

Supervisor (Name & Title)

Starting Position

Starting Salary
F.T

P.T.

F.T.

P.T.

Ending Salary

Ending Position

Phone Number (include area code)

May we contact?

No Selection
Responsibilities and Accomplishments
Reason for Leaving

During the past seven years, have you been convicted of, or released from prison for any felony?

Yes

No

If yes, please explain:

(Prior convictions will not necessarily bar applicants from employment.)

Please read carefully before signing:

The above statement(s) are true and accurate. I understand that any misrepresentation or omission of facts is cause for dismissal. I hereby authorize UniSea Group to investigate
any and all statements contained herein and request the persons, firms or corporations named above to answer any and all questions relating to this application and any employment based thereon. I hereby release from all liability UniSea Group and any person, firm or corporation who provides information concerning my prior education, employment
or character. If employed, I understand that my employment is an employment at will and may, regardless of the date my wages and salary are paid, be terminated at any time
without prior notice.

Signature of Applicant

Date