Application for Employment

Questions marked with an asterisk (*) are required.
Please consider printing a copy of this page for your records before you click Submit.

Should you have questions while you are completing this application, please contact our Human Resources Department.

Human Resources
1-800-451-8910; Ext 707
(360) 370 - 7707
jobs@rocheharbor.com

Please note: Roche Harbor has completed our International hiring for 2019 J-1 visas for this year. We are no longer participating in the H2B Visa program. Accordingly, we are no longer accepting International employment applications at this time.

* First Name:

Middle Initial:

* Last Name:

* Country:

* Current Street Address or PO Box:

* City:

* State or Province:

* Zip or Postal Code:

* Primary Phone:

(xxx) xxx-xxxx

Alternate Phone:

(xxx) xxx-xxxx

* Email Address:

What is your permanent mailing address?

Best way to contact you:

Primary Phone

Alternate Phone

* Are you eligible to work in the US?

Yes No

If hired, you will be asked to provide proof that you are eligible to work in the United States.

Roche Harbor Experience

* Have you ever worked at Roche Harbor before?

Yes No

If yes, when and which job?

Names of relatives working at Roche Harbor:

Please provide details (name of newspaper, website, school, company or referring employee, etc.)

Housing

Roche Harbor has very limited availability of employee housing. Please note that pets are not permitted in employee housing, and that all residents in employee housing must be employed by Roche Harbor.

Do you have available housing on San Juan Island?

Yes No

Will you need employee housing?

Yes No

If yes, do you have a roommate preference?

Please note: Most Roche Harbor seasonal positions require availability from mid-May through September 2, 2019 (Labor Day) including weekends.

* Earliest date you can begin employment:

mm-dd-yyyy

Latest date to end employment:

mm-dd-yyyy

If you are applying for a seasonal job, please enter the latest date you can end employment.

Select the positions you are applying for:

*First Choice

Second Choice

Third Choice

* Work Location Preference:

Indoors

Outdoors

No Preference

* Schedule Preference:

On Call

* Shift Availability:

Swing (2pm - 10pm)

Any and/or All Shifts

Day (7am - 5pm)

Evening (4pm - 12am)

Graveyard (12am - 8am)

* Weekly Availability:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

INTERNATIONAL APPLICANTS -

J-1 Visa Programs:

Please return to our website to view the visa programs available for international applicants for 2019.

H-2B Visa Program:

At this time, Roche Harbor is unable to accept applications from candidates residing outside the U.S.

High School Information

High School Name:

City / State:

Number of Years Completed:

* Did you graduate / GED?

Yes No

College Information

College/ University:

City/State:

Number of Years Completed:

Did you graduate?

Yes No

Diploma/Degree:

Yes No

Major Course:

Other training, certifications, languages or special skills relevant to the position for which you are applying.

Please provide your work history for the last five years, starting with your current or most recent employer.

* Most Recent Employer (REQUIRED):

* Employer Name:

* Position Title:

* Job Duties:

* Start Date:

mm-dd-yyyy

End Date:

mm-dd-yyyy

* Reason for leaving:

* Mailing Address:

Mailing Address (cont.):

* City:

* State or Province:

* Zip or Postal Code:

* Phone:

(xxx) xxx-xxxx

* Supervisor:

Supervisor's E-mail Address:

* Eligible for rehire?

Yes No

* May we contact?

Yes No

Second Most Recent Employer:

Employer Name:

Position Title:

Job Duties:

Start Date:

mm-dd-yyyy

End Date:

mm-dd-yyyy

Reason for leaving:

Mailing Address:

Mailing Address (cont.):

City:

State or Province:

Zip or Postal Code:

Phone:

(xxx) xxx-xxxx

Supervisor:

Supervisor's E-mail Address:

Eligible for rehire?

Yes No

May we contact?

Yes No

Third Most Recent Employer:

Employer Name:

Position Title:

Job Duties:

Start Date:

mm-dd-yyyy

End Date:

mm-dd-yyyy

Reason for leaving:

Mailing Address:

Mailing Address (cont.):

City:

State or Province:

Zip or Postal Code:

Phone:

(xxx) xxx-xxxx

Supervisor:

Supervisor's E-mail Address:

Eligible for rehire?

Yes No

May we contact?

Yes No

* List three (3) personal strengths you have:

* List one (1) personal weakness:

Optional - Please attach resume

Upload a .pdf, .doc, .docx, .rtf, .odt, .jpg, .png, .wps, or .txt file less than 2MB.

Please provide two professional references for people who can speak about your employment history.

* First Reference:

* Name:

* Occupation:

* Relationship:

* How long have you known this person?

* Mailing Address:

* City:

* State or Province:

* Zip or Postal Code:

* Phone:

(xxx) xxx-xxxx

E-Mail Address:

* Second Reference:

* Name:

* Occupation:

* Relationship:

* How long have you known this person?

* Mailing Address:

* City:

* State or Province:

* Zip or Postal Code:

* Phone:

(xxx) xxx-xxxx

E-Mail Address:

Background Verification

Criminal History

* Have you ever been convicted of a felony?

Yes No

If yes, please list the charge(s), date(s), and specific details.

* Are there any felony charges pending against you?

Yes No

Disclosure of a criminal record will not necessarily disqualify you from employment. Each conviction will be evaluated on its own merit, with regard to the time, circumstances and seriousness to the position for which you are applying.

Driving History

* Do you have a valid driver's license?

Yes No

State of Issue:

Will you have a car at Roche Harbor?

Yes No

Age Verification

* State and Federal laws may impose a minimum age requirement on certain positions. If necessary for the job are you:

14-15

16-17

18-20

21 or over

Certification / Authorization

I represent / certify that the information presented on this Application and my Resume to be truthful, accurate, and complete to the best of my knowledge. I understand that misleading or false statements will constitute sufficient cause for refusal of hire or termination of my employment.

I further understand that neither the acceptance of this application, nor the subsequent entry into any type of employment relationship with Roche Harbor creates an actual or implied contract of employment. I understand and agree that if I accept employment with Roche Harbor such employment will be on an “At Will” basis. This means that either Roche Harbor or I have the right to terminate our employment relationship at any time, for any reason, with or without cause.

I agree to submit to drug and alcohol testing if requested by Roche Harbor. I hereby release Roche Harbor, and its employees, plus other persons or companies, from any and all liability arising out of or related in any way to such testing.

I hereby authorize Roche Harbor to conduct a comprehensive personal background investigation to verify information concerning my education, employment experiences, and all other aspects of my background relevant to my proposed employment. I release Roche Harbor and its employees from all liability arising from such investigation.

THANK YOU AGAIN FOR FAVORING ROCHE HARBOR.

ROCHE HARBOR IS AN EQUAL OPPORTUNITY EMPLOYER AND PROMOTES A DRUG FREE WORKPLACE

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* Signature:

* Date:

Please be patient while your application is processed.

Application for Employment

Personal Information

Roche Harbor Experience

Housing

Application Information

Please note: Most Roche Harbor seasonal positions require availability from mid-May through September 2, 2019 (Labor Day) including weekends.

INTERNATIONAL APPLICANTS -

J-1 Visa Programs:

H-2B Visa Program:

Education Information

High School Information

College Information

Work History

* Most Recent Employer (REQUIRED):

Second Most Recent Employer:

Third Most Recent Employer:

References

* First Reference:

* Second Reference:

Background Verification

Criminal History

Driving History

Age Verification

Certification / Authorization

THANK YOU AGAIN FOR FAVORING ROCHE HARBOR.