Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email Address
*
Phone
*
(###)
###
####
Driver's License State
*
Driver's License Expiration
*
MM
DD
YYYY
High School
Graduated
If no, did you receive a GED?
College
Graduated
Position Applied For
*
Wheelhouse
Tankerman
Deckhand - Experienced
Deckhand - No Experience
Shore Side/Office
Date Available
*
MM
DD
YYYY
How did you hear about this position or Dupre Marine?
Website
Facebook
Instagram
Personal Referral
Dupre Marine Employee
Marine Industry
Walk-in
TikTok
Other
If you were referred by a Dupre Marine Transportation, please mention their name
First Name
Last Name
Have you ever been employed by Dupre Marine Transportation?
*
If yes, what position did you work?
Captain
Relief Captain
Pilot
Mate Pilot
Tankerman
Deckhand
Shore Side
Have not worked for DMT
Employment History
*
Give complete record of all employment including military, and reasons for periods of unemployment during the last 10 years.
If you have been self-employed list up to 4 of your major clients.
List employers in reverse order starting with the most recent.
Regulated USCG- Applicants who will be wheelmen are required to supply information on those employers for whom the applicant operated such vessels.
No "See Resume" responses will be accepted.
Previous Starting Date
MM
DD
YYYY
Previous End Date
MM
DD
YYYY
Is this a current employer?
*
May we contact your current employer?
*
Contact Person
First Name
Last Name
Company Phone #
*
(###)
###
####
Position Held
*
Start Date
*
MM
DD
YYYY
End Date
MM
DD
YYYY
Reason For Leaving
*
Comment on Reason for Leaving
Was this position subject to USCG regulation?
*
Was this position regulated by Federal or State drug and alcohol testing requirements?
*
Employer #2
Contact Person
First Name
Last Name
Company Phone #
(###)
###
####
Position Held
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Reason for Leaving
Comment on Reason for Leaving
Was this position subject to USCG regulation?
Was this position regulated by Federal or State drug and alcohol testing requirements?
Employer #3
Contact Person
First Name
Last Name
Company Phone #
(###)
###
####
Positition Held
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Reason for Leaving
Comment on Reason for Leaving
Was this position subject to USCG regulation?
Was this position regulated by Federal or State drug and alcohol testing requirements?
Reference #1
*
First Name
Last Name
Phone #
*
(###)
###
####
Years Known
Business or Personal (not related)
Reference #2
First Name
Last Name
Phone #
(###)
###
####
Years Known
Business or Personal (not related)
Reference #3
First Name
Last Name
Phone #
(###)
###
####
Years Known
Business or Personal (not related)
Do you have a legal right to work in the United States?
*
Are you a US Citizen or a Permanent Resident of the United States?
*
Did you serve in the US Armed Forces?
*
If YES, please fill out questions below
(Copy of DD214 is required)
If No, please proceed to next section
Date of Entry
MM
DD
YYYY
Date of Discharge
MM
DD
YYYY
Branch
Rank at Entry
Highest Rank Attained
Rank at Discharge
Overseas Service?
If Yes, how long were you overseas?
Description of Duties
List any Special Training you received
1. Have you ever been convicted or adjudicated of a crime?
*
California applicants: Do not identify convictions under California Health & Safety Code §§11357(b) or (c), 11360(b)
(formerly subdivision (c) of section 11360), 11364, 11365, or 11550 related to marijuana offenses that occurred two or more
years before the instant application. Also, do not identify any conviction for which the record has been judicially ordered
sealed, expunged or statutorily eradicated, or any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed.
2. Are you currently under any investigation or pending charge?
*
3. Are you currently awaiting trial for any criminal offense?
*
4. Have you ever initiated an act of violence in the workplace?
*
5. Have you ever been sanctioned or had your driver's license suspended or revoked?
*
APPLICANT'S STATEMENT AND ACKNOWLEDGMENT
*
1. I certify that this application was completed by me and that all of the information furnished on this application and during
the application process is true, complete and correct to the best of my knowledge.
2. I understand that any misrepresentation or omission of facts called for on this application or during the application process
may result in termination of the application process or my dismissal from employment at any time regardless of when the false
answer or omission is discovered.
3. I authorize the Company to conduct any necessary investigations or inquiries regarding my background to the extent
permitted by federal, state and local law. I agree to complete the requisite authorization forms for the background investigation.
I hereby release all parties from any liability in connection with the provision and use of such information.
4. I understand that if offered employment, I am to abide by all rules and regulations of the Company.
5. I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will
be an at-will employee, meaning that either the Company or I may end the employment relationship at any time with or
without cause.
6. I understand and agree that, except for employment-at-will status, if hired my wages, hours, working conditions, job
assignment(s), and compensation rate(s) will be subject to change by the Company.
7. I understand that the Company may share the information contained in this application with other Company employees for
employment and administrative purposes and hereby consent to such transfer.
8. I consent to all of the following pre-employment processes, which are required by the Company and I further understand
that the offer of employment is contingent upon my successfully completing all of pre-employment testing:
a. Motor Vehicle Report (MVR) (review of past driving record)
b. Drug screen (DOT and Non-DOT applicants)
c. Previous Employer Drug and Alcohol History (49 U.S.C. §§ 40113, 44702, 44703, 44709, 49 CFR
Part 40.25)
d. Physical Examination and Functional Capacity Evaluation (consistent with federal and state law)
e. Background Check
9. I agree and understand that this application for employment in no way obligates the Company to employ me.
Print Name
*
First Name
Last Name
Date of Application
*
MM
DD
YYYY
A. Do you currently posses a license as Captain?
*
If Yes, List License Number and Expiration
B. Have you ever been denied , suspended, and/or revoked a Merchant Mariner Credential (MMC)?
*
C. Do you currently posses a STCW endorsement?
If yes, List Number and Expiration Date
D. Have you tested positive, or refused to test, on any pre-employment, random, follow-up or periodic testing drug or alcohol test administered a maritime employer to which you applied for, but did not obtain, safety-sensitive transportation work Covered by DOT agency drug and alcohol testing rules during the past five (5) years as defined under 46 CFR 16.201?
*
E. If you answered yes to D, can you provide/obtain proof that you've successfully completed the DOT Return-to-Duty requirements?
*
F. Do you currently posses a TWIC (Transportation Worker Identification Card)?
*
A TWIC card is a requirement to work on a vessel, if you do not have one however it is applied for you may still apply for this position and follow-up when the card is in your possession.
Date of Incident #1
MM
DD
YYYY
Incident Description (Fire, Spill, etc)
Fatalites/Injuries
At Fault?
Date of Incident #2
MM
DD
YYYY
Incident Description (Fire, Spill, etc)
Fatalities/Injuries
At Fault?
Date of Incident #3
MM
DD
YYYY
Incident Description (Fire, Spill, etc)
Fatalities/Injuries
At Fault?
1. Work in confined spaces?
2. Work outdoors?
3. Work Aloft?
4. Work overhead (painting, chipping, etc)?
5. Work with pneumatic and power tools?
6. Work bent over or squatting for long periods of time?
7. Lift 30 pounds and carry it 50 feet?
8. Walk up a ships ladder while the vessel is rolling and/or pitching?
9. Climb a 30 foot mast?
10. Enter a tank opening 18 inches in diameter?
11. Throw a mooring line 15 feet to a bit?
12. Stack 1.25" anchor chain in a confined chain locker?
13. Wear and use an oxygen breathing aparatus?
14. Wear and use the following safety equipment?
Check all that apply
15. Splice Line?
Do you have working knowledge of the following?
Radar:
Radar Plotting:
VHF Radio Procedures:
SSB Radio Procedures:
Ships' Compass:
Steering (Helmsmanship):
Gyro:
Auto Pilot:
Fire Fighting:
Fire Extinguisher:
Chart Reading:
Chart Plotting:
Chart Navigation:
Celetial Navigation:
Basic First Aid:
Additional Information
Please let us know if there is anything you would like to add in addition to the above information provided.
Today's Date
*
MM
DD
YYYY
Our Personnel Department will get back to you if a position is suitable and available at this time. This application is considered active for sixty (60) days. This application for employment in no way obligates Dupre Marine to employ you.
If you are contacted for an interview please be sure to have your credentials available for your position including TWIC card and valid driver’s license. Be prepared if you are offered a position at Dupre Marine, if will be contingent upon the following:
• Completion of a satisfactory background check.
• Pre-employment USCG Drug & Alcohol screen.
• Satisfactory reference checks.
• Verification of Credentials
• Pre-employment physical
• Motor Vehicle Report (MVR)
Thank you for submitting an application with Dupre Marine Transportation!
