Employment

Complete if applicable to the position for which you are applying:

(A separate driver’s qualification application must be completed)

STATEMENT OF CERTIFICATION I hereby certify that this application (and accompanying resume, if any) is true and complete, contains no willful misrepresentation or falsification, and that the information given by me is true and accurate. I understand that findings of any misrepresentation, falsification, or omission could result in the rejection of my application or in the immediate termination of my employment. I authorize all previous and current employers, or anyone identified as a reference, to give any and all information concerning my employment history to the Company, and I release all parties of any and all liabilities from any damage, which may result from the furnishing of such information. If I am hired, I understand that my employment will be for no definite period of time, regardless of the period of payment of my wages. I further understand I have the right to terminate my employment at any time, with or without notice, and that the Company has the same right. I agree that the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like, as they may exist from time to time, shall not serve as such writing to modify the at will nature of my employment. No one other than the CEO, COO or the CFO, of the Company has the authority to modify the at will nature of the employment relationship or make any agreement to the contrary. Any such modification must be in writing. I agree to submit to any physical examination and/or lawful drug and alcohol integrity testing that may be required as a post-offer condition of employment. I understand that any offer of employment will be contingent upon successful results of a drug screen, physical examination, or background investigation, if applicable. I certify and agree to the above. Applicant Signature type your name Date AFFIRMATIVE ACTION QUESTIONNAIRE Confidential and Voluntary Samuels and Son Seafood Co. are committed to an Affirmative Action Program which includes giving full consideration for employment to qualified individuals without regard to race, color, religion, gender or national origin. The following information is being requested of all applicants for employment. You’re providing this information is strictly voluntary. The self-identification request is made in compliance with the regulations issued by the U.S. Department of Labor. Responses will be used for the purpose set forth in these regulations. Its purpose is to assist Samuels and Son Seafood Co. in monitoring its Affirmative Action Program and to aid in complying with required Governmental record keeping and periodic reporting. A copy of the AAP is available during normal business hours (call your local personnel office). This information is not part of the employment application. It will be processed separately and will not be considered in the employment/selection process. If you choose to provide information, please complete the following: Name: Sex: Male Female Last 4 digits of Social Security Number: Job Applied for: RACE/ETHNICITY (check one): American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Hispanic or Latino (All races) Hispanic or Latino (White race only) Hispanic or Latino (all other races) * To comply with OFCCP regulations, a visual observation may be made to gather the above demographic data. Enter the code below: *Information must be provided to submit form captcha Prev Applying at Samuels Seafood The Company uses the following procedures concerning its Employment Application. These procedures are to streamline the application process and to ensure compliance with various laws and regulations the Company follows in accepting and considering job applications. If you do not follow these procedures, your application will not be considered. As used in this Application, "Company" refers to Samuels and Son Seafood Co. The Application must be completed fully. A resume may be attached as a supplement, but it is not a substitution for fully, truthfully, and accurately completing the Application. Do not list or identify on the application information that reveals your race, creed, color, national origin, age, religion, disability, or sex. You will be asked to voluntarily provide this information in a separate document the Company maintains as required by various laws. Do not provide information that is not specifically requested. The Company is proud to be an Affirmative Action/Equal Opportunity Employer, M/F/D/V. NOTICE: This Application is considered active for thirty (30) days from the date submitted. For further consideration after this date, a new application must be submitted. Next How did you hear about the company? If you have a resume, please attach here: Cover Letter Type or paste cover letter here LOCATION & POSITION Select Location: Philadelphia Pittsburgh Las Vegas Orlando Job Category: Sales Marketing Accounting General Office Warehouse Drivers Other Position Desired: PERSONAL INFORMATION First Name Middle Name Last Name Street Address City State Zip Telephone Mobile E-mail * Information must be provided to submit form Are you over the age of eighteen? Yes No Did someone refer you? If so, please list their full name. Yes No Have you been previously employed by a company in the seafood business or by the Company? Yes No If yes, when? For whom? Are you legally eligible for employment in the country? Yes No Are you currently on welfare or unemployment? Yes No Are you currently on lay-off status and subject to recall? Yes No May we contact your current employer? Yes No Do you have any relatives employed by the Company? Yes No If yes, please list What hours, shifts or days are you seeking to work? Note: Answering “Yes” to the following question will not automatically eliminate you from consideration for employment. Have you ever been dismissed, terminated, or forced to resign from any employment? Yes No If yes, please give date and details of each such termination of employment: PrevNext SKILLS & QUALIFICATIONS Summarize any training, skills, licenses, and/or certifications that may qualify you for this position. Summarize any equipment you operate, software with which you are familiar or any additional information that may qualify you for this position. EDUCATION High School School Name, City, State Last Grade/ Level Completed Diploma or Degree Course/ Major College, Business, Vocational or Other Training School Name, City, State Last Grade/ Level Completed Diploma or Degree Course/ Major Graduate/ Professional School Name, City, State Last Grade/ Level Completed Diploma or Degree Course/ Major Are you currently unemployed? Yes No If yes, please give the date you were first unemployed PrevNext EMPLOYMENT HISTORY Please list the names of your present or previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time including any military service and any period of unemployment. If self-employed, give firm name and supply business references, and, if necessary, request a continuation page to fully and accurately complete this section. Employer 1 Start / Finish Date Employer Name Telephone Job Title Employer Address, City, State, and Zip Immediate Supervisor & Title Job Duties Reason(s) for Leaving Starting Rate/ Salary Final Rate/ Salary Employer 2 Start / Finish Date Employer Name Telephone Job Title Employer Address, City, State, and Zip Immediate Supervisor & Title Job Duties Reason(s) for Leaving Starting Rate/ Salary Final Rate/ Salary Employer 3 Start / Finish Date Employer Name Telephone Job Title Employer Address, City, State, and Zip Immediate Supervisor & Title Job Duties Reason(s) for Leaving Starting Rate/ Salary Final Rate/ Salary Employer 4 Start / Finish Date Employer Name Telephone Job Title Employer Address, City, State, and Zip Immediate Supervisor & Title Job Duties Reason(s) for Leaving Starting Rate/ Salary Final Rate/ Salary Professional References (No personal references please) Name Title/Company Telephone PrevNext SPECIALIZED SKILLS Complete if applicable to the position for which you are applying: Clerical Applicants How many words per minute do you type? What are your computer skills? What software applications do you use proficiently? Other machines? Driving Applicants (A separate driver’s qualification application must be completed) Do you have a valid drivers license? Yes No Do you have access to a car or other motorized vehicle? Yes No Do you have or can you obtain liability insurance on such a vehicle? Yes No Are there any restrictions on your driver’s license? Your driving record will be checked if you drive a company vehicle. Yes No List Driver's License Information Number Exp Date Class Class of Equip. Type of Equip. ex. Van, Tank, Flat Approx. # of Miles Give State, Year and Number (if known) of all other Licenses held in the last seven years: State Year Number State Year Number Accident Record For Last Three Years Date Nature of Accident (head on, rear...) Fatalities Injuries PrevNext STATEMENT OF CERTIFICATION I hereby certify that this application (and accompanying resume, if any) is true and complete, contains no willful misrepresentation or falsification, and that the information given by me is true and accurate. I understand that findings of any misrepresentation, falsification, or omission could result in the rejection of my application or in the immediate termination of my employment. I authorize all previous and current employers, or anyone identified as a reference, to give any and all information concerning my employment history to the Company, and I release all parties of any and all liabilities from any damage, which may result from the furnishing of such information. If I am hired, I understand that my employment will be for no definite period of time, regardless of the period of payment of my wages. I further understand I have the right to terminate my employment at any time, with or without notice, and that the Company has the same right. I agree that the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like, as they may exist from time to time, shall not serve as such writing to modify the at will nature of my employment. No one other than the CEO, COO or the CFO, of the Company has the authority to modify the at will nature of the employment relationship or make any agreement to the contrary. Any such modification must be in writing. I agree to submit to any physical examination and/or lawful drug and alcohol integrity testing that may be required as a post-offer condition of employment. I understand that any offer of employment will be contingent upon successful results of a drug screen, physical examination, or background investigation, if applicable.

Fish's Wholesale. are committed to an Affirmative Action Program which includes giving full consideration for employment to qualified individuals without regard to race, color, religion, gender or national origin. The following information is being requested of all applicants for employment. You’re providing this information is strictly voluntary. The self-identification request is made in compliance with the regulations issued by the U.S. Department of Labor. Responses will be used for the purpose set forth in these regulations. Its purpose is to assist Fish's Wholesale in monitoring its Affirmative Action Program and to aid in complying with required Governmental record keeping and periodic reporting. A copy of the AAP is available during normal business hours (call your local personnel office). This information is not part of the employment application. It will be processed separately and will not be considered in the employment/selection process. If you choose to provide information, please complete the following: