Personal Information :
First Name

Middle Name * (not required if you do not have one)

Last Name

E-mail

Retype your e-mail

Are you 21 years or older?
Choose one Yes, I am over 21 years of age No, I am not 21
Address

City

State
Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory
Zip

Home Phone

* Cell Phone (not required)


Have you applied at Seals before? :
Choose one Yes, I have applied at Seals before No, Yes, I have NOT applied at Seals before

Position Applying for now :

Full or Part Time:
Choose one Part time Full time

Do you have any prior convictions? :
Choose one Yes, I have a conviction No, I do not have a conviction

Driver's License Number:

What state issued your Driver's License?
Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory

Level of EMS Certification :

EMS Certification Number

State Certified In
Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory
* National Registry Number (not required if you do not have one)

Other Degrees or Certifications

Highest Level of Education


Current Employer :

From (month / year)

To (month / year)

Name Used

Company Address

Supervisor's Name

Reason for Leaving

Phone Number

Job Title and Responsibilities

May we Contact this Employer?
Choose one Yes, you may contact my present employer No, please do NOT contact my present employer

Past Employer :

From (month / year)

To (month / year)

Name Used

Company Address

Supervisor's Name

Reason for Leaving

Phone Number

Job Title and Responsibilities

May we Contact this Employer?
Choose one Yes, you may contact my past employer No, please do NOT contact my past employer

APPLICANT AGREEMENT AND CERTIFICATION

The information I have provided herein is correct and complete to the best of my knowledge. I understand that if I misrepresent or deliberately leave out a fact in my application, I may be refused employment or, if employed, I may be terminated. I authorize SEALS to contact previous employers, except where otherwise noted, for reference and verification of statements made. SEALS has my authorization to investigate my medical and personal history for job-related purpose. I will not hold any official SEALS representative liable for giving or receiving information in this investigation.

I understand that if I am employed by SEALS that I may terminate my employment at any time and that SEALS may terminate my employment without notice or cause. I agree to abide by the rules and regulations of SEALS and I understand that no department head or SEALS official, other than the President of SEALS has any authority to enter into any agreement, verbal or written, concerning length of employment, wages, benefits or other conditions of employment. If terminated, SEALS is liable only for wages or salary earned as of the date of my termination.

I understand and agree that I may be required to take a physical examination and a drug test as a condition of employment for the purpose of determining my abilities to perform job duties now or in the future. I agree to consent to take such tests at such time as determined by SEALS and to release SEALS and its official representatives from any claims arising in connection with the use of information resulting from such examination.

I understand that SEALS may investigate my financial and credit history and I hereby authorize SEALS to investigate my financial and credit history. Further, I hereby authorize anyone of whom request is made to supply to SEALS any information concerning my background in connection with my being considered for employment with SEALS.

I understand that SEALS operates as a Drug Free Workplace and should I be employed by SEALS I will be subject to drug testing including random testing; probable cause testing; pre-employment screening; and post accident and injury testing and I voluntarily agree to participate in SEALS’ drug testing.

The Indiana Uniform Electronic Transactions Act 2000 Indiana House Bill 1395, allows you to sign this application by using your initials. This electronic signature is just as valid as a pen and paper signature and is valid in a court of law in the state of Indiana. My electronic signature verifies I entered all this information to be true and correct.