OFFSHORE INTERNATIONAL MARINE PERSONNEL SERVICES, INC. EMPLOYMENT APPLICATION

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1 OFFSHORE INTERNATIONAL MARINE PERSONNEL SERVICES, INC W. Nvy Bvd Po, FL Tho: (850) Tx: (850) EMPLOYMENT APPLICATION Poo Ay Fo Nm: F L SS# - - Add Cy/S Z Pho: Hom _ ( ) C_ ( ) Oh _ ( ) Em Add Emy Co Po: Nm Roh Add Pho _ ( ) You oud b kd o dv omy vh. I o, do you hv vd Dv L? Y No Eduo: Hh Shoo Gdu: Y No Co Co Gud L o Edom S T NOTE: WHEN FAXING OR MAILING BACK THIS APPLICATION, PLEASE SEND A COPY OF YOUR ID, MERCHANT MARINERS DOCUMENT AND ANY COAST GUARD LICENSES. Do No W I Th S Fo O U Oy P 1 o 9

2 WORK HISTORY; 1. Comy m Pho Add Suvo Fom o Sy Poo Rob Ro o v 2. Comy m Pho Add Suvo Fom o Sy Poo Rob Ro o v 3. Comy m Pho Add Suvo Fom o Sy Poo Rob Ro o v 4. Comy m Pho Add Suvo Fom o Sy Poo Rob Ro o v P 2 o 9

3 WORK HISTORY 5. Comy m Pho Add Suvo Fom o Sy Poo Rob Ro o v 6. Comy m Pho Add Suvo Fom o Sy Poo Rob Ro o v I hby y h h quo o h o hv b wd uhuy, d h mo o my w h o d my u o o moym by h moy. Su D RELEASE OF INFORMATION/BACKGROUND INVESTIGATION I,, do hby v Oho Io M Po Sv, I., mo o o o my d moy, d o odu bkoud vo dmd y. I uh hod Oho Io M Po Sv, I., o y b h my u om uh vo. I udd h h omo w b d o y d ov moy. Su D P 3 o 9

4 NOTICE TO APPLICANTS/EMPLOYEES REGARDING CONSUMER REPORTS A oum o Co omo o you moym hoy, m od, d moo vh od my b obd oo wh you o o d/o oud moym wh h omy. A oum o o juy d od d md omo my b obd v o o moym h b md. Bo y dv o k, bd who o o h omo od h oum o, you w b ovdd oy o h o, h m, dd d ho umb o h o y, ummy o you h ud h d o, w ddo omo o you h ud h w. * * * * * * * * * * * * CONSENT TO OBTAINING CONSUMER REPORTS READ CAREFULLY BEFORE SIGNING 1) I HAVE READ THE ATTACHED NOTICE TO APPLICATION/EMPLOYEES REGARDING CONSUMER REPORTS AND HEREBY AUTHORIZE THE COMPANY TO OBTAIN CONSUMER REPORTS AS DESCRIBED PRINT YOUR NAME SIGNATURE DATE MIBS FORM 1 Vo 1.2 P 4 o 9

5 P 5 o 9

6 PRIVATE EMPLOYMENT SERVICES CONTRACT 1. Th o d o by d bw H d o h A d OFFSHORE I NTERNATI ONAL MARI NEPERSONNELSERVI CES,I NC.h d o h Em oym S v.a m m by w h m oy ob wo k. 2. Shoud moym wh moy o whh h moym v h d hm/h wh o y om h d o h o, h o y o oo v dd od wh h hdu od h #4. Th o b md by h y y m by w o, bu o o h dm o y h o obo ud o o uh mo. 3. A hby o xu yo hk m m d md ow o o y u ho z h m oy m v o v y o hk, y o h b m d m h md o w o d ou h md ow o oy. 4. Th o o v m h bb do h oj dd y w, mud m ou (14) dy. 5. Uo o job, h moym v h vo whh h u m d h v o o h.th m h b d od wh m o h md ow o oy udd o bov d o h m, md ow o oy, d m m h b m d h o odo v( 5 )y h omod ow o oy x. 6. Th m o d y w oud h o h uo o omu v h d o wy u h oud moym o y. Th d by h moym v wh moym d yb oow: No dow ym qud! Pym w b 20% o o y o h yo hk u h b d y. *********************************GUARANTEE******************************** Wh oud moym md o y o whov wh y (90) ouv d dy oow h d moym b, h h h h o xd wy o h o o h. Rud du h ud h b md omy by h moym v uo o vo o. P 6 o 9

7 Wh uh ym h b md o h ou (14) dy om d vo w vd. Th h b ob o ob vo o om h moy. Wh moyd moym bu o o o wok o h w job d m wh h/h moy, h hd o uh h o xd wy (20%) o h o m oo. ****************************************************************************** 7. A hby u d o y y o wy-v (25%) oy, u ou o, o h d du h moym v houd bom y o h v o ob ou, oo v, o o o ou o o o m. 8. I udood h y o o h o o wh Lou Pv Emoym Sv Lw, o h u d uo bhd hud, h h ovo o w, u d uo h ov. Th do h y o o h o o wh h ovo o w h o d h md o h o u, d o h d, h o o h o dd vb. OFFSHORE INTERNATIONAL MARINE PERSONNEL SERVICES, INC., h w o ud y o o h o mk mo h o v h o y o m. Th ho kowd o oy o h o; hy hv d d udd ovo ho d o bd by m d odo. SIGNATURE OF APPLICANT DATE SOCIAL SECURITY NUMBER OFFHSORE INTERNATIONAL MARINE PERSONNEL SERVICES, INC. P 7 o 9

8 NOTE: R: PAYROLL DEPARTMENT Chk M Am I HEREBY AUTHORIZE, o (hk o bow) M my yhk o m h bow-d v. D do my yhk o h ow hk ou o h bow-d v. OFFSHORE INTERNATIONAL MARINE PERSONNEL SERVICE, INC W. Nvy Bvd. Po, F Su o A PRINT NAME S.S. NUMBER Pm Add Cy, S, Z Hom Pho Numb Bo m, h udd uhoy o h dy oy d kow o m o b h o who m ubbd o h oo um. Gv ud my hd d h dy o, 201 Noy Pub d o, Cy S P 8 o 9

9 LIMITED POWER OF ATTORNEY TO: OFFSHORE INTERNATIONAL MARINE PERSONNEL, INC. KNOW ALL BY THESE PRESENTS: THAT I, ( m dssn#) : (Pm m dd): (Cy, d z od): (Hom ho umb): D o xu LIMITED POWER OF ATTORNEY, do hby mk, m, ou d o OFFSHORE INTERNATIONAL MARINE PERSONNEL SERVICES, INC./ THOMAS F. BREWER, my u d wu d oy o m d my m, d d o om h oow m: Uo o my yo hk om my moy, you o do d IMMEDIATELY do uh hk o h A E owa ou ooffshorei NTERNATIONAL MARINE PERSONNEL SERVICES, INC., wh h ow o u obu d x u v y o h dd bu m o u d. You uhozd o u hk om uh ou o my bh o h oow uo: 1. To OFFSHORE INTERNATIONAL MARINE PERSONNEL SERVICES, INC., od wh o my o o ym o h uhozd m. m 2. To my o mou o w m h m h b d. Chk ud o m h b md o o h m d bow: CHECK ONE: ( ) Hod ow hk d moy hk ub OFFSHORE INTERNATIONAL MARINE PERSONNEL SERVICES, INC., u I k hm u, o u I oy you o m hm o m. ( ) M ow hk h m o u, o wh moy hk ub o m h dd d bov. W: A S u BEFORE ME, h udd uhoy, d h o om w d bov, o h dy oy d h dvdu kow by m o b h o who m ubbd o h um, d kowdd o m h h xud h Pow o Aoy o h uo d odo od h. Gv ud my hd Th dy o, 20 NOTARY PUBLIC IN AND FOR, (Ph o Couy) (S) P 9 o 9

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