PO Box 70438
4601 Shilshole Ave NW
Seattle WA 98127
(206) 789-1930
(800) 426.6783
As an equal opportunity employer, we consider applicants for all positions without regard to race, color, religion, creed, gender identity,
national origin, age, disability, genetic information, marital or veteran status, or any other legally protected status.
Please complete the following application honestly and completely.
Unanswered questions may result in your application not being accepted.
Position(s) Applied For:
Date of Application:
How Did You Learn About Us?
Advertisement
Friend ______________________
Employment Agency
Other ______________________________
(Friends Name)
Last Name:
Address
First Name
Number &Street
Home Telephone:
(Please List)
Middle Name
Apt #
City
State
Cellular Telephone:
Zip Code
Social Security Number:
Are you 16 years of age or older?
Yes
No
Are you able to perform the essential functions of the position with or without accommodations?
Yes
No
Yes
No
Yes
Yes
Yes
No
No
No
Yes
No
Have you ever been employed with Western Pioneer, Inc. dba Alaska Ship Supply before?
If yes, give date ____________________________________________
Do any of your friends or relatives, other than spouse, work for Western Pioneer, Inc. dba Alaska Ship Supply?
If yes, state name and relationship ________________________________________________________
Are you currently employed?
May we contact your present employer?
Are you legally eligible for employment in the United States?
Proof of citizenship or immigration status will be required upon employment.
Date available for work _____/______/______
What is your desired salary range $____________ ___________
Are you Available to work
Full Time
Part Time
Temporary From:___________To:___________
Education
School
Name and Location
of School
Course of Study
High School
College/University
Trade or
Professional
Additional
SKILLS AND QUALIFICATIONS
Types of computers, software and other equipment you are qualified to operate or repair:
Other qualifications such as special skills, abilities or honors that should be considered:
Professional Licenses, certification or registrations:
Over →
Years
Completed
Diploma/
Degree
Page 2 of 2
Work Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude
organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.
Employer:
Dates of Employment
Duties/Skills
From
Address:
To
Phone Number:
Daily or Hourly Rate
Job Title:
Starting
Final
Supervisor:
Reason for Leaving:
Employer:
May We Contact?
Yes
Dates of Employment
From
Address:
No
Duties/Skills
To
Phone Number:
Daily or Hourly Rate
Job Title:
Starting
Final
Supervisor:
Reason for Leaving:
Employer:
May We Contact?
Yes
Dates of Employment
From
Address:
No
Duties/Skills
To
Phone Number:
Daily or Hourly Rate
Job Title:
Starting
Final
Supervisor:
Reason for Leaving:
May We Contact?
Yes
No
I certify that the answers given herein are true and complete.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 60 days; after that time, if I wish to be considered for
employment, I must submit a new application.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with Western Pioneer, Inc. is of an
“at will” nature, which means that the Employee may resign at any time and Western Pioneer may discharge Employee at any time with or without cause.
It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is
specifically acknowledged in writing by an authorized executive of Western Pioneer, Inc.
I understand that employment requires the successful completion of a drug and/or alcohol test as a condition of employment.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I
understand, also, that I am required to abide by all rules and regulations of Western Pioneer, Inc.
__________________________________________
Signature of Applicant
_____________________________
Date