Office of the Harwich Harbormaster
Job Application
PO Box 207, Harwich Port, MA 026457

Position applying for:
Assistant Harbormaster/Wharfinger	Harbor Assistant (Dock Attendant)	Prinicipal Clerk	Watchman	Shellfish Lab Tech

Full Name:

Telephone:

Permanent Address:

Island Address:

EDUCATION

Name of School

Year Graduated

Concentration

High School

College

Previous Employ

Position

Dates from/to:

Contact Name

Phone/Address

Personal Reference

Phone

Address

Relationship to Applicant

Emergency Contact*

Phone

Address - Physical (Street)

Relationship to Applicant

* Someone we can contact in case of emergency on the job.

Work Experience (list other pertinent job experience for job applied for):

Licenses or Certificates you possess:

Driver's License Boating Safety Course - Date: __________ Lifeguard

CPR USCG License - Date: __________ Other: _______________________

Can you swim? Yes  No

Date of Birth: ________________  Start Work Date: ________________

Social Security #:

I certify that the above information is correct and complete to the best of my knowledge. It is agreed that any misrepresentation or omission of pertinent facts may be considered cause for termination or the withdrawal of an offer for employment. The Town of Harwich is an equal opportunity employer.

Signature of Applicant: _________________________________________

Date: _______________

Fax completed application to (508) 432-5039. Mail to Office of the Harwich Harbormaster, PO Box 207, Harwich Port, MA 02646.
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