Allied Shipyard, Inc.

310 Ledet Lane
Larose, LA 70373

Phone: (985) 693-3323
Fax: (985) 693-3687

Required fields are noted with a (*).

GENERAL
Name: *   SS#:
Present Address: *
City/State: *   Zip Code: *
Home Phone: *  Cell Phone:
Are you over the age of 18? Yes No   Date of Birth: (Optional)
Height:  Weight:  Position Applied for:
Date you can start:   Salary Desired:
Have you ever been convicted of a crime except a minor traffic violation? Yes No
Can you fulfill all requirements and meet all qualifications of the job? Yes No
If no, please explain:
 
EDUCATION
Level Name/Location Years Attended Graduated Subject Studied
1.  
2.  
3.  
 
EMPLOYMENT
Please list at least (3) of your last employers and dates employed, complete with a phone number and/or location of their home office.
1.
2.
3.

Are you Drug Free at this time? Yes No
Will you pass a urinalysis test? Yes No

Direct Deposit Only. You must have a checking or savings account with your name on the account. Do you have an account open? Yes No
Electronic Signature (full name): *     Date: