Address Are you able to perform the essential functions of If necessary for the job I am able to: the position with or without accommodations* Work overtime* Yes No Yes No Provide a valid Alaska Driver's License Yes No If necessary for the job are you older than: If so fill out the following: Issuing state: 14 15 16 (Check one) Type: 18 19 21 Endorsement (s): Hazardous Material Passengers I am legally eligible for employment in the U.S.* Tankers Tank with Hazardous Materials List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here in the summary following this section or on an extra sheet of paper if necessary. No more than 10 years history recommended. Employer name and address Position title/duties skills: Start date: End date: Reason for leaving: Pay $ Are you a veteran Yes No Duty/specialized training QUALIFICATIONS Other qualifications such as special skills, abilities or honors that should be considered: Types of computers, software, and other equipment you are qualified to operate or repair:

Highlights:

• Email
• Software
• Typing
• Forklift
• Team Player
• Inventory
• Procurement
• Shipping/Receiving