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Job Application

GENERAL INFORMATION

Applicant Name*
Other names used (if any):
Home Phone:
-
Message Phone:
-
Cell Phone:
-
E-mail*
Address:*
Are you a U.S. Citizen?*
If no, do you have the legal right to live and work in the U.S?
VISA TYPE:
Number:
Expiration Date:
Have you been employed by any Mills Marine and Ship Repair Organization?*
Which companies?
Start Date:
End Date:
Check if you are under age 18:

(A work permit maybe required if under 18)

RELEVANT INFORMATION

Job Title applying for:*
If Other is selected, enter Job Title applying for:
Department:
Referred by: (Name)
Referrer Phone:
-
Do you hold a United States Government Security Clearance or are capable of obtaining one?*
If Yes, what level:
Do you currently possess a TSA Transportation Worker Identification Card (TWIC)?*

EDUCATION/PROFESSIONAL ACTIVITY

School 1:
School 2:
School 3:
School 4:

LICENSE/CERTIFICATION/REGISTRATION

License 1:
License 2:
Drivers License:

For positions in which driving may be a part of your job, you will need to provide proof of automobile insurance and a current driving record.

EMPLOYMENT INFORMATION

Employer:
Type of Business:
Employer 1 From:
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Employer 1 To:
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Employer 1 Address:
Employer 1 Job Duties:
Reason For Leaving Employer 1:
Employer 1 Final Salary:
Employer 2:
Employer 2 Type of Business:
Employer 2 From:
 / 
 / 
Employer 2 To:
 / 
 / 
Employer 2 Address:
Employer 2 Job Duties:
Reason For Leaving Employer 2:
Employer 2 Final Salary:
Employer 3:
Employer 3 Type of Business:
Employer 3 From:
 / 
 / 
Employer 3 To:
 / 
 / 
Employer 3 Address:
Employer 3 Job Duties:
Reason For Leaving Employer 3:
Employer 3 Final Salary:
Employer 4:
Employer 4 Type of Business:
Employer 4 From:
 / 
 / 
Employer 4 To:
 / 
 / 
Employer 4 Address:
Employer 4 Job Duties:
Reason For Leaving Employer 4:
Employer 4 Final Salary:
Employer 5:
Employer 5 Type of Business:
Employer 5 From:
 / 
 / 
Employer 5 To:
 / 
 / 
Employer 5 Address:
Employer 5 Job Duties:
Reason For Leaving Employer 5:
Employer 5 Final Salary:
Skills:
Trade:
Trade Name:
Electrician:
What License?:
Welding:
Type of certification:
Have you ever been fired, discharged, or asked to resign from any position?*
Please Explain:
Have you ever been convicted of a felony?*
Have you ever been convicted of a misdemeanor?*

If your answer is yes to either question, please give the date, nature of offense, and explain the circumstance in the text box below. Include a copy of your judgement, as soon as possible, to be considered. A conviction record will not necessarily bar you from employment.

Circumstances:

EQUAL OPPORTUNITY EMPLOYER

Mills Marine and Ship Repair is an Equal Opportunity Employer. The information below is needed to fulfill Federal Equal Employment Opportunity reporting requirements.

RACE, ETHNICITY, AND GENDER INFORMATION

American Indian/Native American:
Alaskan Native:
Asian or Pacific Islander:
African American:
Hispanic/Latino:
Caucasian:

DEFINITIONS OF RACE/ETHNIC GROUP


The racial/ethnic groups for affirmative action programs and Federal reporting purpose are defined as follows:


AMERICAN INDIAN/ NATIVE AMERICAN: Any person having origins in any of the peoples of North America, and who retains cultural identification through tribal affiliation or community recognition.
ALASKAN NATIVE: Any person having origins in any of the original peoples of Alaska, and who retains cultural identification through tribal affiliation or community recognition. Alaskan Native may include, for example, any person of Yup’ik, Inupiat, Aleut, Athabascan, Tlingit, or Haida origin.
ASIAN OR PACIFIC ISLANDER: Any person having origins in any of the original peoples of The Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa.
AFRICAN AMERICAN: (Not of Hispanic origin); any person having origins in any of the Black racial groups of Africa.
HISPANIC/LATINO: Any person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture origin, regardless of race.
CAUCASIAN: (Not of Hispanic origin); any person having origins in any of the original peoples of Europe, North Africa, or the Middle East.

How did you hear about this position?:
List if Other:

VETS-100 EMPLOYMENT SURVEY

The Federal Contractor Veterans’ Employment Report (VET-100) program is intended to assist the Department of Labor in determining whether special disabled and Vietnam-era veterans benefit from affirmative action in obtaining and advancing in employment. The information on this survey is voluntarily provided and will be kept confidential. Disclosure or refusal to provide the information will not subject the applicant or employee to any adverse treatment and the information will be used only in support of veteran’s programs in accordance with the regulations implementing 38 U.S.C.4212.

Please check all categories that apply to you.
SPECIAL DISABLED VETERAN (Please check if either or both categories apply to you)

A veteran who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans Affairs for a disability (a) rated at 30 percent or more, or (b) rated at 10 or 20 percent in the case of a veteran who has been determined under Section 1506 to Title 38, U.S.C. to have a serious employment handicap:
A veteran who was discharged or released from active duty because of a service-connected disability.

VETERAN OF THE VIETNAM-ERA (Please check if either or both categories apply to you)

A veteran who served on active duty for a period of more than 180 days, and was discharged or released therefrom, with other than a dishonorable discharge, if any part of such active duty occurred: (1) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (2) between August 5, 1964 and May 7, 1975 in all other cases
A veteran who was discharged or released from active duty for a service connected disability if any part of such active duty was performed: (1) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (2) between August 5, 1964 and May 7, 1975 in all other cases.

OTHER VETERANS (Please check if either or both categories apply to you)

A veteran with active duty service at any point between December 7, 1941 and April 28, 1952
A veteran with active duty service at any point in a campaign or expedition for which a campaign badge has been authorized. The campaigns or expeditions that meet this criterion as of August 31, 1999 are identified on the reverse side of this document. (Since new campaigns and expeditions are added from time to time, they can be identified via the Internet at http://www.opm.gov/veterans/hrml/vgmedal2.com). A veteran qualifies under this criterion ONLY upon military service IN the identified campaign or expedition and NOT simply based on any military service during the time of the campaign or expedition. The campaign badges, service medals, and expeditionary medals that qualify under this criterion will be listed in the veteran’s “Armed Forces of the U.S.Report of Transfer or Discharge,” commonly known as the “DD-214 Form” if the veteran meets this criterion.
NONE OF THE ABOVE:

EMPLOYMENT APPLICATION DISCLAIMER

Mills Marine & Ship Repair is an Equal Opportunity Employer and selects the best matched individual for the job based
upon related qualifications, regardless of race, color, religion, sex, age, national origin, disability, genetic information,
veteran status, or any other classification protected by federal, state, or local law.

I understand and agree that:

1. It is my understanding that Mills Marine & Ship Repair will make a thorough investigation of my entire work history
and may verify all data given in my application for employment, related papers, or oral interviews. I authorize such investigation
and the giving and receiving such information. Any material misrepresentation or deliberate omission of a fact in my application
may be justification for refusal of, or if employed termination from employment.

2. We are a Drug Free Workplace, and we conduct Pre-Employment and random drug testing.

3. I agree that my employment may be terminated by Mills Marine & Ship Repair at any time without liability for wages or
salary except such as may have been earned at the date of such termination.

4. I authorize any physician or hospital to release any information, including the result of drug or alcohol abuse screening,
which may be necessary to determine my ability to perform the duties of a job I am being considered for. Prior to employment or in
the future during my employment with Mills Marine & Ship Repair, I consent to take a medical examination by qualified
physician at the discretion of my employer.

5. Although management makes every effort to accommodate individual preferences, business needs may at times make the following
conditions mandatory: overtime, shift work, a rotating schedule other than Monday through Friday. I understand and accept these
conditions of employment.

6. I understand that Virginia is an “At-Will” state and employment with Mills Marine & Ship Repair is for no definite
period of time.

If you have read and understood the above, please enter your name here as your signature:

Digital Signature:*

Please select Today's Date:

Date:*

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