Online Application

First Name

Middle Name

Last Name

Date of Birth

You must be over 18 to apply. Are you under the age of 18?

Yes No

Social Security Number
If you are hired, your social security number will be verified with the SSA

Mailing Address

City, State, Zip

Physical Address

City, State, Zip

Phone Number where you can be reached

Name and
Phone Number
for emergency contact

(name)
(phone)

Sex:

Relatives Employed by Great Pacific Seafoods, Inc.

Name and Address of Authorized Person to Pick up Pay Check:

Name
Street
City
State
Zip

Have you ever worked for Great Pacific before?

Yes No

If Yes, When?
Where?

Type of work applying for:

Do you have reliable transportation to work?

Yes No

Are you currently employed?

Yes No

Date you can start

Position Desired

Salary Desired

Today’s Date

Employment History

Dates Employed

Name/Address of Employer

Name
Street
City
State
Zip

Salary

Position

Reason for Leaving

Dates Employed

Name/Address of Employer

Name
Street
City
State
Zip

Salary

Position

Reason for Leaving

Dates Employed

Name/Address of Employer

Name
Street
City
State
Zip

Salary

Position

Reason for Leaving

Dates Employed

Name/Address of Employer

Name
Street
City
State
Zip

Salary

Position

Reason for Leaving

References

Name

Address

City
State
Zip

Business

Years Known

Phone Number

Name

Address

City
State
Zip

Business

Years Known

Phone Number

Name

Address

City
State
Zip

Business

Years Known

Phone Number

Name

Address

City
State
Zip

Business

Years Known

Phone Number

Education
Grammar School
Name/Location of School	(name) (location)
Last Year Completed
Did you Graduate?	Yes No
Subjects Studied
High School
Name/Location of School	(name) (location)
Last Year Completed
Did you Graduate?	Yes No
Subjects Studied
College
Name/Location of School	(name) (location)
Last Year Completed
Did you Graduate?	Yes No
Subjects Studied
TradeBusiness
Name/Location of School	(name) (location)
Last Year Completed
Did you Graduate?	Yes No
Subjects Studied

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including Race, Color, Age, Sex, Religion, or National Origin .

Two pieces identification are required at the time of applying for a job. One picture ID and a Social Card. We will need a completed I-9 in order to accept this application. Applications will not be accepted without the proper identification . Any questions about what identification is accepted can be directed at the employer.

Health Questionnaire

Personal Medical History. Please mark answers to all questions! Have you ever had or have you ever been treated for:

	Yes	No	If yes, explain.
Epilepsy
Diabetes
Arthritis
Amputated foot, leg, arm or hand
Loss of sight of one eye or both eyes
Loss uncorrected vision
Spondyiolisthesis
Residual disability from polio
Cerebral Palsy
Multiple sclerosis
Parkinson’s disease
Cerebral vascular accident
Tuberculosis
Cardiac Disease
Silicosis
Hemophilia
Chronic Osteomyelitis
Osteoporosis
Ankylosis of joints
Hyperinsulinism
Muscular dystrophies
Arteriosclerosis
Trombophlebitis
Varicose Veins
Heavy Metal poising
Ionizing radiation injury
Compressed Air Sequelar
Ruptured Intervertebral Disc

THE INFORMATION PROVIDED IN THIS APPLICATION FOR EMPLOYEMENT IS TRUE, CORRECT AND COMPLETE. IF EMPLOYED, ANY MIS-STATEMENT OF FACTS ON THIS APPLICATION MAY RESULT IN MY DISMISSAL.

I UNDERSTAND THAT ACCEPTANCE OF AN OFFER OF EMPLYMENT DOES NOT CREATE A CONTRACTUAL OBLIGATION UPON THE EMPLYER TO CONTINUE TO EMPLY ME IN THE FUTURE.

SIGNATURE: DATE:

IF YOU DECIDE TO ENGAGE AN INVESTIGATIVE CONSUMER REPORTING AGENCY TO REPOR TON MY CREDIT AND PERSONAL HISTORY, I AUTHORIZE YOU TO DO SO. IF A REPORT IS OBTAINED, YOU MUST PROVIDE AT MY REQUEST, THE NAME OF THE AGENCY SO I MAY OBTRAIN FORM THEM THE NATURE AND SUBTANCE OF THE INFORMATION CONTAINED IN THE REPORT.

SIGNATURE: DATE:

GREAT PACIFIC SEAFOODS, INC.

ANCHORAGE , ALASKA 99502

PHYSICAL RECORD
DO YOU HAVE ANY PHYSICAL OR MENTAL CONDITIONS WHICH MAY LIMIT YOUR ABILITY TO PERFORM THE JOB YOU APPLIED FOR?		Yes No
IF YES PLEASE DESCRIBE THE CONDITION AND HOW YOU CAN PERFORM THE JOB IN SPITE OF IT:
DO YOU HAVE ANY PHYSICAL OR MENTAL CONDITIONS WHICH PREVENT YOU FROM PERFORMING ANY SPECIFIC JOBS OR JOB TASKS?		Yes No

HAVE YOU HAD ANY ILLNESS OR ACCIDENT SIN THE PAST FIVE YEARS THAT WOULD AFFECT YOUR EMPLOYMENT?		Yes No

ARE YOU CURRENTLY ON ANY MEDICATIONS OR UNDER?		Yes No

ARE THERE ANY FACTS WE SHOULD BE AWARE OF AS TOYOUR; MENTAL OR PHYSICAL HEALTH IN REGARDS TO YOUR EMPLOYMENT WITH US?		Yes No

IN CASE OF EMERGENCY WHO SHOULD WE NOTIFY?
NAME
PHONE

THE INFORMATION PROVIDED IN THIS APPLICATION FOR EMPLOYMENT IS TRUE, CORRECT AND COMPLETE. IF EMPLOYED, ANY MIS-STATEMENT OF FACT ON THIS APPLICATION MAY RESULT IN MY DISMISSAL. I UNDERSTAND THAT ACCEPTANCE OF AN OFFER OF EMPLOYMENT DOES NOT CREATE A CONTRACTUAL OBLIGATION UPON THE EMPLOYER TO CONTINUE TO EMPLOY ME IN THE FUTURE. IF YOU DECIDE

TO ENGAGE AN INVESTIGATIVE CONSUMER REPORTING AGENCY TO REPORT ON MY CREDIT AND PERSONAL HISTORY I AUTHORIZE YOU TO DO SO.

IF A REPORT IS OBTAINED, YOU MUST PROVIDE AT MY REQUEST , THE NAME OF THE AGENCY SO I MAY OBTAIN FORM THEM THE NATURE AND SUBSTANCE OF THE INFORMATION CONTAINED IN THE REPORT.

EMPLOYEE SIGNATURE:

DATE:

If you have further questions please email jobs@greatpacificseafoods.com