International Longshoremen’s Association Application

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Social Security Card (Required) *

High School Diploma or Equivalent (Required) *

Any photo uploaded, other than what it requested in your application will not be processed:

Transportation Worker Identification Credentials (TWIC):

Do you have a TWIC: *

Yes

Have you applied for a TWIC? *

Yes

If yes, what was the date of the application? *

Full Name *

Have you ever been known by any other name? *

Yes

If yes, list all: *

Current Address: *

Phone Number *

Email Address *

Emergency contact name and phone number

Full Name

Last Name

Phone

Social Security Number: *

Emergency contact name and phone number: *

Driver’s License Number: *

Expiration Date: *

Own a vehicle or have reliable source of transportation? *

Yes

If no, explain:

Are you a citizen of the United States? *

Yes

Authorized to work in the U.S.? *

Yes

Have you ever been convicted of a felony? *

Yes

If yes, explain: *

Other areas of residence in previous 7 years and dates: *

Military Service

Have you served in any branch of the U.S. Military? *

Yes

Previous Employment

Company: *

Phone: *

Address: *

Supervisor: *

Salary/Hourly Wage: *

Duties: *

Dates employed: *

Reason for leaving: *

Company: *

Phone *

Address: *

Supervisor: *

Salary/Hourly Wage: *

Duties: *

Dates employed: *

Reason for leaving: *

Company: *

Phone *

Address: *

Supervisor: *

Salary/Hourly Wage: *

Duties: *

Dates employed: *

Reason for leaving: *

Please list and explain any prior equipment operator experience, including but not limited to forklift, heavy lift, yard tractor, or cranes: *

Please list any computer experience and software proficiency below: *

Have you been employed by 1351 in the past?

Yes

Education

High School/GED: *

Dates attended: *

Student Name: *

Degree received if completed: *

College: *

Dates attended: *

Student Name: *

Degree received if completed: *

Trade/Other: *

Dates attended: *

Student Name: *

Degree received if completed: *

Please list the names and numbers of four references below that we may contact that are not former employers, not relatives, and who have known you for at least three years. *

Are you available every day of the week? *

Yes

Are there any hours during available days that you are unable to work? *

Yes

Are you currently employed? *

Yes

How were you referred? *

Explain *

Authorization

I hereby declare that all statements contained in this application are true and correct and I understand that false, misleading, or inaccurate information in this application will be the basis for withdrawal of any employment offer or, if employed, may result in dismissal.
In connection with my application for employment, I authorize and understand that this release acknowledges that the WGMA/ILA may at any time in the future, prior to my employment or while I am employed, conduct a background investigation including a public record research report containing information for verification of prior employment, academic achievement, and financial history (including pursuant to the Fair Credit Reporting Act), use of a motor vehicle, general background, and personal character. This release shall include, but not be limited in its scope or purpose for reasons of business necessity.
I authorize and request all persons, schools, corporations, credit bureaus, courts, law enforcement agencies, armed forces, employment commissions, and all governmental agencies to release any and all information without restriction or qualification. I authorize a photocopy of this release to be considered as effective and valid as the original. All results will be proprietary and confidential and will not be provided to any parties other than WGMA/ILA or its legal representatives. I am aware that I have to a right to request the nature and scope of the results, as reported from company hired to conduct the research (if any). I unconditionally release and voluntarily waive all recourse and legal liability, including liability for defection, and release the requested parties from liability for complying with this request/release.
I understand WGMA/ILA is committed to providing a drug free workplace. I have been provided with a copy of the WGMA/ILA Drug abuse and testing policy. I understand that WGMA/ILA will require drug and alcohol screens upon an offer of employment, through random work premises testing, when there is suspicion, and whenever an on-the-job accident or injury is reported. I further understand that this test may be required of only the person involved or required of all employees within the area of occurrence. My signature on this application acknowledges my consent and release to be personally tested by WGMA/ILA and their designated medical/testing service. It is understood and agreed that any and all disputes involving this Policy, including interpretation or application, must be resolved solely under the Grievance and Arbitration Procedures under the Collective Bargaining Agreements. Resolution reached on any and all disputes under the Grievance and Arbitration Procedures are binding on all parties.
I agree to make myself fully available for work assignments involving each of the types of equipment of which I am being certified if employment and certification is granted.
I understand that completing this application in no way guarantees employment with the WGMA/ILA.

This Authorization has been explained to me in a language I understand, and I have been advised of the answers to any questions I have about the policies. I understand that this agreement is a legal and binding document.

Applicant Signature *

Date Signed *