STA-ILA SENIORITY BOARD

**EMPLOYMENT APPLICATION FORM**

Name	Port #	Phone #

First	M.I.	Last

Address

Number	Street	Apt. #	City	State	Zip Code

Seniority Classification:	Email:

Job Vacancy applied for: Employer: Gang:

Position applied for:

Other: (specify)

References: Other port employers for whom you have performed work like this job vacancy.

Company	Pier

A.

B.

Waterfront experience:	Number of years worked on the waterfront:

Give details of waterfront experience:

FAILURE TO ANSWER THE FOLLOWING TWO QUESTIONS AUTOMATICALLY VOIDS THIS APPLICATION

Are you presently on any other list?

If ‘yes’, name of company and gang.

I understand that I must vacate my current job if I am successful in getting the job applied for on this form.

CAUTION: “Anyone who applies for a job and works at least one day at that job will automatically be removed from their previous job. If he/she then refuses the job after working one day, he/she will be designated a 00.”

Signature of Applicant (Application Void if questions 1 & 2 are not answered truthfully)	Date

APPLICATION MUST BE RECEIVED AT THE SENIORITY BOARD OFFICE

at 8615 Ridgely’s Choice Drive, Suite 202, Baltimore, MD 21236 by mail,

or Emailed to System@sta-balto.com, or Faxed to 410-248-3378

NO LATER THAN 4:30 P.M. ON THE EXPIRATION DATE

***********************************************************************************