Senesco Marine - Employment Application

Senesco Marine, LLC
10 MacNaught Street
North Kingstown, RI 02852-7414
www.senescomarine.com
401.295.0373

Application For Employment

Senesco Marine, LLC complies with all Federal, State and Local Laws prohibiting discrimination.

SENESCO MARINE SUBCRIBES TO A DRUG AND ALCOHOL FREE WORKPLACE!

GENERAL INFORMATION
Name (Last, First, MI)	Home Telephone	Cell Phone

Mailing Address (No. Street)

E-mail address

City

State

Zip Code

Position(s) you are applying for:

Are you able to work all shifts?
Yes No

Are you eligible to work in the United States?
Yes No

Proof of eligibility will be required at the time you start work.

Are you 18 years of age or older?
Yes No

Have you ever worked for Senesco?
Yes No

Name any relatives or friends working at Senesco:

EDUCATIONAL BACKGROUND

Highest
education level
completed

Grade School
4	5	6	7	8

High School
9	10	11	12

College/Tech
1	2	3	4	5

Grad School
1	2	3	4	5

Military Service:
Yes No

Branch

Number of Years Served & Type of Discharge:

GENERAL SKILLS & QUALIFICATIONS (CHECK ALL THAT APPLY)

Blueprint Reading

Brake Press Operator

CNC Plasma Cutter Operator

Forklift Operator

Oxy Fuel Cutting

Pipefitter

Rigger

Shipfitter

Theodolites

Crane Operator:

T/R

Overhead

Crawler

Welder:

Stick

Fluxcore

MIG

Subarc

Computer Skills:

Mac

Computer Programs (List)

Other Operating Skills

PREVIOUS EMPLOYMENT (List all employers for past 5 years)

Company:		Telephone:
Address:		Supervisor:
Job Title	Salary		Dates of Employment: FromTo
Responsibilities		Reason for Leaving:
May we contact your supervisor?Yes No

Company:		Telephone:
Address:		Supervisor:
Job Title	Salary		Dates of Employment: FromTo
Responsibilities		Reason for Leaving:
May we contact your supervisor?Yes No

Company:		Telephone:
Address:		Supervisor:
Job Title	Salary		Dates of Employment: FromTo
Responsibilities		Reason for Leaving:
May we contact your supervisor?Yes No

Company:		Telephone:
Address:		Supervisor:
Job Title	Salary		Dates of Employment: FromTo
Responsibilities		Reason for Leaving:
May we contact your supervisor?Yes No

Company:		Telephone:
Address:		Supervisor:
Job Title	Salary		Dates of Employment: FromTo
Responsibilities		Reason for Leaving:
May we contact your supervisor?Yes No

REFERENCES
Name:	Relationship:	Telephone No.:
Name:	Relationship:	Telephone No.:
Name:	Relationship:	Telephone No.:
Name:	Relationship:	Telephone No.:

JOB REQUIREMENTS (Essential Job Functions)
The following are considered to be essential job functions of an employee of Senesco Marine, LLC:
	1.	Employees are required to work in open air or in buildings that are not heated or cooled, in all seasons including winter.
	2.	Employees are required to work in close proximity to motor vehicles, railroad tracks, overhead and stationary cranes, forklifts and other heavy and industrial equipment.
	3.	Employees are required to work on the waterfront and/or over water.
	4.	Employees are required to work in confined spaces and under artificial lighting and are required to stand, crouch and kneel for long periods of time.
	5.	Employees are required to access the work area and may be required to climb, work on stairs, ladders, scaffolding, man lifts, and vessels or similar structures up to 80 feet.
	6.	Employees are required to work with computers, hand tools and powered tools, and around such tools and equipment, which includes welding.
	7.	Employees are required to be able to lift up to 75 pounds frequently.
	8.	Employees are required to work and complete assigned shifts and are required to perform their work at Senesco Marine, LLC's facilities.

ACKNOWLEDGEMENT OF BEING ABLE TO PERFORM ESSENTIAL JOB FUNCTIONS WITH OR WITHOUT REASONABLE ACCOMODATION
I acknowledge that Senesco Marine, LLC has informed me of the essential job functions of the position(s) for which I am applying, and I further acknowledge that I am able to perform the essential functions of said position(s) with or without reasonable accommodation.
Dated:	Signature (Type Name Here):

EMPLOYMENT AT WILL
I understand and agree that if offered employment by Senesco Marine, LLC, my employment will be as an "employee-at-will" and that I may be discharged by Senesco Marine, LLC at any time with our without cause. I also understand and agree that this "at will" employment relationship may not be changed by any written document or by conduct unless it is specifically acknowledged in writing by an authorized executive or Senesco Marine, LLC expressly changing the nature of the "at will" employment relationship.
Dated:	Signature (Type Name Here):

RHODE ISLAND WORKER'S COMPENSATION LAW SECTION: 28-35-57.1
R.I. Worker's Compensation Law Sec. 28-35-57.1 states: "An employee's claim for compensation from an employer under chapters 29 to 38 of this title shall be barred from the date the employee commences employment for a period of two (2) years in the event the employee has willfully provided false information as to his or her ability to perform the essential functions of the job, with our without reasonable accommodations, on an employment application, requesting that information, if the information is directly related to the personal injury which is the basis for the new claim for compensation. This section shall not apply unless the employment application advises the employee of the substance of this section. Nothing in this section shall exempt any employer from or excuse full compliance with any applicable provisions of the Americans with Disabilities Act, 42 U.S.C. Sec. 12101 et seq. and chapter 87 of title 42." I acknowledge having read R.I. Worker's Compensation Law Sec. 28-35-57.1 as part of this employment application, and, as a result, I acknowledge having been advised by Senesco Marine, LLC of the substance of that law.
Dated:	Signature (Type Name Here):

ACKNOWLEDGEMENT AND RELEASE
I authorize Senesco Marine, LLC to perform an investigation of my background in furtherance of my application for employment and agree to cooperate in said investigation and agree to release Senesco Marine, LLC and any and all parties providing information in connection with such an investigation from any liability. I understand and agree that any offer of employment by Senesco Marine, LLC is contingent upon the results of post-offer, pre-employment testing for illegal use of drugs and a medical examination to determine my ability to perform job related essential functions with or without reasonable accommodation. I further understand and agree that employment with Senesco Marine, LLC is subject to all lawful orders, rules, regulations and standards of conduct required by Senesco Marine, LLC, including rules and regulations concerning use of illegal drugs and alcohol.
Dated:	Signature (Type Name Here):

APPLICANT STATEMENT
I certify that the above responses given by me are true and accurate to the best of my knowledge. I understand that Senesco Marine, LLC has relied upon the above responses given by me in considering my application, and that in the event I have provided willfully false responses in this application I will be subject to dismissal.
Dated:	Signature (Type Name Here):



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