Application for Employment with
Washington State Ferries
RETURN THE COMPLETED APPLICATION TO
Washington State Ferries
Attn: HR - Summer Hire
2901 3rd Ave, Suite 500
Seattle, WA 98121-3014
Please review all questions carefully before preparing your application.
POSITION (Job Title for which you are applying)
WSFSummerHiring@wsdot.wa.gov
NAME (Last, First, and Middle Initial)
ON-CALL TERMINAL EMPLOYEE
MAILING ADDRESS (include apartment number, if any)
CITY
SOCIAL SECURITY NUMBER (for identification only)
COUNTY
STATE
ZIP
PRIMARY TELEPHONE
(
EMAIL ADDRESS
)
SECONDARY TELEPHONE
(
)
US COAST GUARD DOCUMENTS
MERCHANT MARINER DOCUMENT AND PROFESSIONAL LICENSE (Please check the appropriate boxes)
1.
A/B Endorsement, Limited/Unlimited (circle what applies)
6.
Chief Engineer License
2.
Mate License
7.
Lifeboatman Endorsement
3.
Master License
8.
OS Endorsement
4.
Oiler Endorsement
9.
TWIC
5.
Assistant Engineer License
10.
Other
Some Graduate Work
EDUCATION (Please check the appropriate boxes)
1.
Vocational School without completing High School
6.
2.
High School Graduate or GED
7.
*
MA./MS./M.S.W. or other Master Degree
3.
Vocational or Business School
8.
*
Other Graduate Degree (Ph.D./L.L.D./M.D./etc.)
4.
Some College (two quarters or more) AA degree
9.
5. *
College Graduate (BA or BS degree) 4 Year College
Less than High School Graduate
*List Major
Are you a high school graduate or have you passed a general education development (GED) test?
YES
NO… If no, then what was your highest grade completed:
List post high school training, including college, business school, military training, and other relevant education.
If more space is needed, attach additional sheets.
Month and
Year
Attended
School Name and Location
1
2
BACKGROUND
From
/
To
/
From
/
To
/
Credits Earned
Quarter
Semester
Other
(Specify)
Major
Type of
Degree
Awarded
Year
Degree
Received
Have you been convicted of a misdemeanor or felony in the past then (10) years?
(Answering Yes will not automatically exclude you from employment.)
Yes
No
Will VISA or immigration status prevent lawful employment
Yes
No
How did you hear about this job?
Terminal Attendant Application
IBU
Online
Personal Reference
Newspaper/Print
Job Fair
Page 1/8
NAME:
EMPLOYMENT HISTORY
This section must be completed. Account for all time within the last ten (10) years. Start with your present or last position, then work
backward.
You may use this form for volunteer as well as paid experience. For volunteer experience, 174.3 hours equals one month’s experience.
If you need more space, you may attach additional sheets.
1. Present or Last Employer
Employer’s Address
Your Title
Start Date (Month/Year)
Immediate Supervisor’s Name
Employer’s Phone Number
End Date (Month/Year)
Reason for Leaving
Total Months
Avg Hrs Per Wk
Last Salary
Volunteer (Y/N)
No. of Employees Supervised
Specific Duties:
2. Present or Last Employer
Employer’s Address
Your Title
Start Date (Month/Year)
Immediate Supervisor’s Name
Employer’s Phone Number
End Date (Month/Year)
Reason for Leaving
Total Months
Avg Hrs Per Wk
Last Salary
Volunteer (Y/N)
No. of Employees Supervised
Specific Duties:
3. Present or Last Employer
Employer’s Address
Your Title
Start Date (Month/Year)
Immediate Supervisor’s Name
Employer’s Phone Number
End Date (Month/Year)
Reason for Leaving
Total Months
Avg Hrs Per Wk
Last Salary
Volunteer (Y/N)
No. of Employees Supervised
Specific Duties:
4. Present or Last Employer
Employer’s Address
Your Title
Start Date (Month/Year)
Immediate Supervisor’s Name
Employer’s Phone Number
End Date (Month/Year)
Reason for Leaving
Total Months
Avg Hrs Per Wk
Last Salary
Volunteer (Y/N)
No. of Employees Supervised
Specific Duties:
DATE AND SIGNATURE
All answers and statements are true and complete to the best of my knowledge.
I understand that the state may verify information, and that untruthful or misleading answers are cause for rejection of this application,
removal of my name from a register, or dismissal if employed.
I also understand that the state will be conducting criminal conviction checks but a conviction record will not necessarily disqualify me from
employment.
To be accepted you must sign and date this application.
Electronic applications do not require a signature. When submitted electronically, you are confirming that all information is true
and complete.
Signature
Terminal Attendant Application
Date (Month/Day/Year)
Page 2/8
Authorization for Release of Personal Record Information
To Whom It May Concern:
I hereby authorize and request any present or former employer, school, police department, financial institution,
division of motor vehicles, or other persons or agencies having personal knowledge about me to furnish bearer
with any and all information in their possession regarding me, in connection with an application for employment. I am willing that a photocopy of this authorization be accepted with the same authority as its original.
All fields must be completed, including Social Security Number and Date of Birth. If we do not have
complete information, we will be unable to complete your background check, and your name will be
removed from the hiring list.
Please Print Carefully
Name (First, Middle, Last)
Phone Number (Daytime)
(Night)
Social Security Number
Date of Birth (for Identification)
(MM/DD/YYYY)
Other Names Used
Dates Used
Dates Used
Dates Used
Current Full Address
Number and Street
City
State
Zip Code
Former Addresses in the Past Five (5) Years (continue on separate sheet if needed)
Dates
Dates
Dates
Driver’s License Number
State
To be accepted you must sign and date this sheet.
Electronic applications do not require a signature. When submitted electronically, you are confirming that all information is true
and complete.
Signature
Terminal Attendant Application
Date (Month/Day/Year)
Page 3/8
What it means to be “On-Call”
for the Terminal Department at Washington State Ferries
•
You may be called to work with one hour’s notice.
•
You may be called to work a shift that starts at 4:00AM.
•
You may be called to work a shift that ends at 2:00AM.
•
You will be assigned to one terminal or terminal grouping.
•
You will be assigned by seniority based on your bid sheet.
•
You may be assigned to both traffic and seller shifts.
Washington State Ferries operates numerous vessels on 8 different routes, 24 hours a day,
seven days a week, 365 days a year, including holidays and weekends. The shift hours and
days vary greatly. On-call employees are generally called to work a shift for an employee
who has called in sick, or is otherwise unavailable on short notice.
As an on-call employee there are no guarantees for hours, shift locations, or advance notice
for work assignments. WSF makes every effort to give on-call employees advance notice of
assignments, but due to the “fill-in” nature of the work that is not always possible.
By your signature you understand the uncertain nature of being an on-call employee at
WSF. You also understand the importance of being available for work when called.
To be accepted you must sign and date this sheet.
Electronic applications do not require a signature. When submitted electronically,
you are confirming that all information is true and complete.
Signature
Terminal Attendant Application
Date (Month/Day/Year)
Page 4/8
Background Assessment Questionnaire
1 Have you received discipline for performance related problems over the past ten years?
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
6 Washington State Ferries has a policy of a drug/alcohol free workplace. Are you able to work within a drug/
alcohol free environment?
YES
NO
7 Have you received discipline for an act of violence or aggression against a co-worker, supervisor or
customer? If yes, please explain
YES
NO
8 Have you received discipline for a violation of a safety rule or policy?
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
If yes, please explain
2 Have you received discipline for harassment, including sexual harassment?
If yes, please explain
3 Have you been disciplined for using illegal substances during work hours?
If yes, please explain
4 Have you received discipline for failure to meet attendance standards?
If yes, please explain
5 Have you received discipline for violating company policies or rules?
If yes, please explain
If yes, please explain
9 Have you received discipline for theft or misuse of company/organization property?
If yes, please explain
10 Have you ever been terminated or resigned in lieu of termination for any reason?
If yes, please explain
11 Have you ever been disciplined for using alcohol while on duty?
If yes, please explain
12 Have you ever been disciplined for being rude/discourteous to a customer?
If yes, please explain
To be accepted you must sign and date this sheet.
Electronic applications do not require a signature. When submitted electronically, you are confirming that all information is true
and complete.
Signature
Terminal Attendant Application
Date (Month/Day/Year)
Page 5/8
Willingness and Ability Assessment
1
Are you dependable?
If no, please explain
YES
NO
2
Do you have any commitment or responsibility that would prevent you from reporting to work every
assigned day? If yes, please explain
YES
NO
3
Are you able / willing to perform all the duties of this position with or without reasonable accommodations?
If no, please explain
YES
NO
4
Are you willing to work with difficult people – both customers and (at times) co-workers?
If no, please explain
YES
NO
5
Are you willing to work in inclement weather?
If no, please explain
YES
NO
6
Are you willing to follow WSF’s Policies, Rules and Procedures?
If no, please explain
YES
NO
7
Are you willing and able to give clear, responsible directions to the public?
If no, please explain
YES
NO
8
Are you willing and able to work cooperatively with other people?
If no, please explain
YES
NO
9
Are you willing to wear a uniform prescribed by WSF?
If no, please explain
YES
NO
10
Are you able to report for work on time?
If no, please explain
YES
NO
11
Are you willing to work unusual hours, weekend, holidays, etc.?
If no, please explain
YES
NO
12
Are you able to follow WSF safety rules?
If no, please explain
YES
NO
13
Do you have any reservations about your ability to meet all the requirements of the position you are
seeking? If yes, please explain
YES
NO
14
Do you have any other commitments or priorities that would preclude you from carrying out the duties
of the position for which you are applying? If yes, please explain
YES
NO
To be accepted you must sign and date this sheet.
Electronic applications do not require a signature. When submitted electronically, you are confirming that all information is true
and complete.
Signature
Terminal Attendant Application
Date (Month/Day/Year)
Page 6/8
Affirmative Action Information
Name (Last, First, Middle Initial)
Date of Birth
1. What race or culture do you consider yourself?
Please check only one group.
Social Security Number
2. Are you
Male
Female
Black / African American (870)
White / Caucasian (800)
3. Are you a veteran?
Asian or Pacific Islander (API)
(If yes, check one box below):
Yes
Chinese (605)
Vietnamese (619)
Filipino (608)
Indian (600)
Hawaiian (635)
Japanese (611)
Korean (612)
Cambodian (604)
Samoan (655)
Laotian (613)
Guamanian (660)
Other API (please list)
Indian (American) (597)
Print or type the name of the enrolled or principal tribe:
No
Vietnam-era Veteran
Disabled Veteran
Percent of disability:
4. Do you have a physical, sensory, or mental condition that
substantially limits any of your major life functions, such as
working, caring for yourself, walking, doing things with your
hands, seeing or hearing?
Yes
No
Eskimo (935)
Aleut (941)
Spanish / Hispanic (if yes, check one box below):
Mexican, Mexican/American, Chicano (722)
5. Do you have a physical, mental or other health condition that
has lasted six (6) or more month and which limits the kind or
amount of work you can do at a job?
Yes
No
Puerto Rican (727)
Cuban (709)
Other Spanish / Hispanic
Print or type one group, such as Colombian, Dominican, Nicaraguan, Spaniard:
Please sign and date this sheet.
Electronic applications do not require a signature. When
submitted electronically, you are confirming that all
information is true and complete.
Other Race (if checked, print or type):
Signature
Date
Affirmative Action Definitions
American Indian or Alaskan Native. A person with origins in any of the
original peoples of North American and who maintains cultural identification
through documented tribal affiliation or community recognition.
Asian or Pacific Islander. A person with origins in any of the original
peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the
Pacific Island. For example, China, Japan, Korea, Pakistan, the Philippine
Republic, and Samoa.
Black/African/American. A person with origins in any of the Black racial
groups of Africa.
Hispanic. A person of Mexican, Puerto Rican, Cuban, Central or South
American, or other Spanish culture or origin regardless of race. For
example, persons from Brazil, Guyana, or Surinam would be classified
according to their race and would not necessarily be included in the
Hispanic category. This category does not include persons from Portugal,
who should be classified according to race.
White/Caucasian. A person with origins in any of the original peoples of
Europe, North Africa, or the Middle East.
Terminal Attendant Application
Disabilities. For Affirmative Action purposes, persons with disabilities
are persons with a permanent physical, mental, or sensory impairment
which substantially limits one or more major life activities. Physical,
mental, or sensory impairment means:
(a) any physiological or neurological disorder or condition, cosmetic
disfigurement, or anatomical loss affecting one or more of the body
systems or functions; or (b) any mental or psychological disorders
such as mental retardation, organic brain syndrome, emotional or
mental illness, or any specific learning disability. The impairment must
be material rather than slight, and permanent in that it is seldom fully
corrected by medical replacement, therapy or surgical means.
Disabled Veteran. A person entitled to disability compensation under
laws administered by the US Department of Veteran Affairs for
disability rated at 30 percent or more, or a person whose discharge or
release from active duty was for a disability incurred or aggravated in
the line of duty.
Vietnam-era Veteran. A person who served on active duty for a
period of more than 180 days, any part of which occurred between
August 5, 1964, and May 7, 1975, and was discharged or released
from duty with other than a dishonorable discharge.
Page 7/8
Veteran’s Information
1.
Have you served honorably in the Armed Forces of the United States on active duty for reasons other than training?
YES
NO
List campaign, expeditionary, or service medals received:
2.
Did you serve in active duty prior to May 8, 1975?
YES
3.
NO
Were you discharged within the last eight years?
YES
4.
NO
Are you receiving a monthly retirement benefit?
YES
5.
NO
Are you a Vietnam-era veteran?
YES
6.
NO
Do you have a service-connected disability?
YES
7.
NO
Are you presently the spouse of a disabled veteran?
YES
8.
If yes, list percent of disability:
NO
Are you presently the surviving spouse of a deceased veteran who died from service-related activities?
YES
NO
List campaign, expeditionary, or service medals spouse received:
9.
If you are a surviving spouse, have you remarried?
YES
10.
NO
Please give dates of your (or your spouse’s) active military service
Date Entered
Branch
Date Separated
You
/
/
/
/
Your Spouse
/
/
/
/
Please sign and date this sheet.
Electronic applications do not require a signature. When submitted electronically, you are confirming that all information is true
and complete.
Signature
Terminal Attendant Application
Date (Month/Day/Year)
Page 8/8
