Muddy Bay Marine - Employment Application

To be considered for employment, every section must be completed in its entirety

Personal Information

Name
Today's Date
Date of Birth
(for background verification)
Permanent Address
Previous Address (if less than 5 years at current address)
If you are not a citizen of the United States, are you eligible to work in the U.S. and would you be able to provide the necessary documents of proof of the legal right to work upon hire?
Are you under age 18?
If you are under 18 and still in high school, you may be required to provide a work permit upon hire.
Have you ever been convicted of any crime other than minor traffic violations?
How were you referred to Statewide?
Have you ever been employed by Muddy Bay Marine, its affiliates, officers or partners?

Employment Interest

Date available

Education and Training

Indicate last level completed:
Indicate Technician Certifications:

Employment History

Please list most recent employer first and account for all time periods

Company Address
May we contact this employer?
Start Date
End Date
Company Address
May we contact this employer?
Start Date
End Date
Company Address
May we contact this employer?
Start Date
End Date

Description Area

Reference 1
Reference 2
Reference 3

Equal Employment Opportunity Information Self Identification

An equal opportunity and affirmative action employer


Statewide Insurance Group, Inc. gathers and maintains certain information on individuals who reside in the US who apply for employment with us. (Those who don’t reside in the United States may disregard this document.) To assist Statewide in maintaining accurate employment records and comply with federal government reporting requirements, your assistance is requested. The information you provide (below) is considered entirely voluntary and confidential, and will be used only for data reporting requirements as required. If you choose not to self-identify, your employment status will not be affected in any way. We request that you complete this voluntary form along with your employment application.


Statewide Insurance Group, Inc. is an Equal Employment Opportunity employer. We conduct all employment-related activities without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation or any other classification protected by applicable sate or Federal employment discrimination laws. Statewide welcomes diversity in the workplace.

Please check the categories, which apply to you:

GENDER (SEX) INFORMATION:
RACE / ETHNIC GROUP INFORMATION
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Date

VIETNAM VETERAN INFORMATION:

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Date

Notice to Employee of Investigation Report Under Fair Credit Reporting Act

Read Carefully and Sign

I certify that the information contained in this application is correct to the best of my knowledge and I understand that any misstatement or omission of information is grounds for ending the hiring process or immediate dismissal. I authorize verification of information provided on this application and authorize the references contained herein to provide to you all written and verbal pertinent information concerning my previous employment, work habits, work history, job performance, and character assessment and hold Statewide harmless and release them from any and all liability and responsibility for such information, however obtained.


I authorize all corporations, companies, educational institutions, persons, law enforcement agencies, and former or current employers to release all written and verbal information about me to any duly authorized officer, partner, or employee of Statewide. I release them from any liability and responsibility for doing so. I also authorize Statewide to procure a consumer/credit/criminal background report (“Consumer Report”) including but not limited to Motor Vehicle Reports, Credit Report, Credit Scores, and CLUE Reports for the purpose of reviewing and determining my worthiness in being appointed, licensed, or contracted (“appointment”) as a Statewide employee or agent and as part of my ongoing employment with Statewide and its affiliates. I release all parties from all liability for any damage that may result from furnishing same to Statewide, its affiliates, officers, partners, or other duly authorized by such to collect. I further agree that the company may terminate my employment with or without cause and without any prior notice, at any time.


I hereby verify the foregoing answers and statements. I authorize Statewide to release, for the purpose of processing my application for employment or appointment, any information obtained to any Statewide Insurance Group affiliate or to the principal of the agency recommending my employment or appointment with this company. I understand and agree that any misrepresentation of fact, whenever discovered, will be the basis for termination for cause of any such appointment.


I hereby certify that I have never been convicted of a state or federal felony crime that would prohibit or disqualify me from participating in the business of insurance. I further understand that should I at any time be convicted of a felony, my employment will be immediately terminated. I agree to release Statewide, its affiliates, officer, partners, and employees from any liability resulting in my dismissal.


I agree to immediately notify your office of any material changes in the above information. I understand no one has authorized me to enter into an employment contract or agreement for employment. I have also been given a standalone consumer notification that a Consumer Report will be requested and used for the purpose of evaluating me for appointment. This authorization, in original or copy form, shall be valid for this and any future reports or updates that may be requested, to the extent allowed by law.

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1. Customer Service Objective

Mr. Charles Trent Lindsey, II a new boat customer of Muddy Bay Marine, special ordered an 800gph aerated livewell pump and control rocker panel switch, which he paid for over 30 days ago. We failed to order his parts. Now Mr. Lindsey is angry when he calls and finds out we do not have his parts and he is fishing a tournament the upcoming weekend. Please hand write a letter to Mr. Lindsey explaining what happened, our response about how we will correct the situation, and that he should expect to receive those items from us in approximately 3 days from now.

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