Application for Employment - Harbor Dredge Worker

Date

First Name

Last Name

Primary Phone Number

Secondary Phone Number

Current Address (Street, City, State, Zip)

EMPLOYMENT DESIRED

Position you are applying for?

If hired, on what date can you start work?

Salary desired:

PERSONAL INFORMATION

Have you ever worked for Santa Cruz Port District before?

Yes

If yes, in what capacity?

If hired, can you present evidence of your legal right to live and work in this country?

Yes

Can you perform the essential functions of the position WITH or WITHOUT reasonable accommodation?

With

Without

Are you a CalPERS retiree (receiving a retirement benefit from CalPERS)?

Yes

EDUCATION, TRAINING, AND EXPERIENCE

School Type (required)

Name and Location of Institution

Number of Years Completed

Did you graduate?

Yes

Degree or Diploma (List)

EDUCATION, TRAINING, AND EXPERIENCE (Continued)

School Type (required)

Name and Location of Institution

Number of Years Completed

Did you graduate?

Yes

Degree or Diploma (List)

EDUCATION, TRAINING, AND EXPERIENCE (Continued)

School Type (required)

Name and Location of Institution

Number of Years Completed

Did you graduate?

Yes

Degree or Diploma (List)

EDUCATION, TRAINING, AND EXPERIENCE (Continued)

Do you have any other experience, training, qualifications, or skills which make you especially suited for work at Santa Cruz Port District?

EMPLOYMENT HISTORY - List below all present and past employment, starting with your most recent employer. (Note: This information is required in addition to any resume or supplemental materials submitted)

Name of Employer

Address (Street, City, State, Zip)

Phone Number

Supervisor's Name

Type of Business

Your Position Title

Your Duties

Dates of Employment

Salary (Starting - Ending)

Reason for Leaving

EMPLOYMENT HISTORY (Continued)

Name of Employer

Address (Street, City, State, Zip)

Phone Number

Supervisor's Name

Type of Business

Your Position Title

Your Duties

Dates of Employment

Salary (Starting - Ending)

Reason for Leaving

EMPLOYMENT HISTORY (Continued)

Name of Employer

Address (Street, City, State, Zip)

Phone Number

Supervisor's Name

Type of Business

Your Position Title

Your Duties

Dates of Employment

Salary (Starting - Ending)

Reason for Leaving

SUPPLEMENTAL QUESTIONS - Please limit each response to 200 words or fewer.

1. Describe any experience you have operating or working on boats or vessels, including workboats, tugs, or other marine craft. Include any relevant training, certifications, or familiarity with marine operations, VHF radio use, or working in and around the water. (required)

2. Describe your mechanical background, particularly any experience you have working with marine diesel and combustion engines, hydraulic systems, pumps, and other electromechanical components used in heavy equipment or marine operations. (required)

3. Describe any relevant training, certifications, or experience you have in areas such as operating heavy equipment, electrical systems, metal fabrication, and welding. (required)

4. Describe your experience performing physically demanding manual labor tasks, such as marine or harbor facility maintenance, dredging work, construction, landscaping, or general infrastructure repair. Include any experience with the safe use and upkeep of hand tools, power tools, and motorized equipment. (required)

LICENSES/CERTIFICATES

Upload copies of licenses/certificates listed on application.

RESUME

Upload Resume (optional)

By clicking the submit button below, I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment may be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize Santa Cruz Port District to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment, and further, authorize my former employers to disclose to the Port District any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Port District, my former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application or conveyed during any interview which may be granted is intended to create an employment contract between me and the Port District. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable periodand may be terminated at any time, with or without prior notice, for any reason, at the option of either myself or the Port District, and that no promises or representations contrary to the foregoing are binding on the Port District unless made in writing and signed by me and the Port District’s designated representative.

NOTE: The Port District has a policy authorizing a physician’s physical fitness exam, together with drug testing of persons who have been offered employment. Individuals who are determined by the physical not to be physically fit for duty, or who test positive for controlled substances, will not be employed. If you have reason to believe that you will not pass a physician’s physical examination or will test positive for the presence of controlled substances, or you are unwilling to consent to such an examination or test if offered employment, it is recommended that you not submit an application.

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