E.C. PHILLIPS & SON, INC.

Producers and Processors of Quality Alaska Seafood

P.O. Box 7095 Ketchikan, Alaska 99901 Phone 907-247-7975 Fax 907-225-7250

Application for Employment

To Complete Please Print PERSONAL INFORMATION
Last Name First Name Middle Name

This company is an equal opportunity employer and does not unlawfully discriminate on the basis of race, sex, age, color, religion, national origin, marital status, veteran status, disability status, or any other basis prohibited by federal, state or local law. Please let us know if you need accommodations in order to participate in the application process.

Social Security Number Telephone Number

Present Address (Street, City, State and Zip Code) Permanent and/or Mailing Address (if different than above)

( (
Will visa or immigration status prevent lawful employment? Yes No If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes During the last seven (7) years, have you been convicted of Nature of Offense any criminal offense involving violent behavior, dishonesty, or breach of trust? Yes No If yes, state the nature of the offense, date and disposition. *PLEASE NOTE: A CONVICTION RECORD WILL NOT NECESSARILY BAR YOU FROM EMPLOYMENT.

) )

Permanent Telephone No.

No Date/Disposition

EMPLOYMENT DESIRED
Date Available From: To:

Position/Job

Who referred you to this company?

Given your knowledge, skills, education and experience, are you able to perform all of the essential functions of the position for which you are applying, with or without reasonable accommodations as set forth in the job description? Yes No If no, please explain fully.

OCCUPATIONAL SKILL/EXPERIENCE

List any additional experience, skills or training applicable to the position for which you are applying:

EDUCATIONAL BACKGROUND
HIGH SCHOOL Name of School: Location of School: Did you Graduate? No Yes Date:___________ No Yes Date:___________ No Yes Date:___________ COLLEGE TRADE OR TECH SCHOOLS

Degree/Studies:_____________

Degree/Studies:_____________

Degree/Studies:_____________

REFERENCES
NAME ADDRESS AND TELEPHONE NATURE OF RELATIONSHIP

Give below the names of two persons not related to you, whom you have known at least one year.

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E.C. PHILLIPS & SON, INC APPLICATION FOR EMPLOYMENT

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E.C. PHILLIPS & SON, INC APPLICATION FOR EMPLOYMENT

WORK HISTORY LIST MOST RECENT EMPLOYER FIRST.

Include at least past five (5) years, and account for any time gaps in your employment history. Attach additional sheet if necessary.

Employer Address

Telephone Number

Position(s) Held and Description of Duties

(
Start

)
Salary / Hourly Rate
End

City and State Name & Title of Supervisor Employer Address

Date Hired
Mo___________/Yr____________

Date Separated
Mo___________/Yr____________

Reason for Leaving Position(s) Held and Description of Duties

Telephone Number

(
Start

)
Salary / Hourly Rate
End

City and State Name & Title of Supervisor Employer Address

Date Hired
Mo___________/Yr____________

Date Separated
Mo___________/Yr____________

Reason for Leaving Position(s) Held and Description of Duties

Telephone Number

(
Start

)
Salary / Hourly Rate
End

City and State Name & Title of Supervisor

Date Hired
Mo___________/Yr____________

Date Separated
Mo___________/Yr____________

Reason for Leaving

(1)

IN CASE OF EMERGENCY NOTIFY:

Phone: ( ) (6) Relationship: If employed, I agree that if E.C. Phillips & Son, Inc. advances or loans any money during the course of my employment, or if I lose, damage, or fail to return any company property, the company is authorized to deduct from my wages sufficient funds to repay such loans or advances or to replace its property. E.C. Phillips & Son, Inc. has a SUBSTANCE ABUSE POLICY strictly prohibiting the use, sale or illegal possession of a controlled substance or drug not medically authorized. Any offer of employment is contingent upon verification by drug screening test that applicant is free from the presence of non-authorized drugs.

Name:

READ CAREFULLY BEFORE SIGNING

I certify that all the information I have provided in this application is true and complete, to the best of my knowledge. I understand that, if employed, falsified statements on this application or failure to furnish all requested information may result in my dismissal. I authorize my former employers, schools, and personal references to provide any information they may have regarding me. I hereby release those persons or entities from all liability for providing such information. I understand that, if employed, I can be terminated at any time with or without cause and with or without notice. I agree to comply with all work rules of the company. Prior to employment I must provide information showing eligibility for employment in the United States and identification.

(2)

(7)

(3) (4) (5)

I have read and understand these seven statements.

_________________________________________________

APPLICANTS SIGNATURE

________________________ DATE

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