Print and mail
or fax this form with payment to have your own custom web page
displayed
$125. for 6 months, $250 for 1 year
Master Card / Visa, Company Check or Money Order
Made payable to Budd Aubry
Contact Budd
Aubry
Absolutely Nautical / Truckaboat
USA
4917 N.E. 18th Terr.
Ft. Lauderdale, Fl. 33308
(954) 202-9284 Fax: (954) 771-2337
email:
budd@truckaboat.com
(Credit Card information)
Card Name: .... Master Card ___ Visa ___
Account #: ________________________________________ Expiration Date ________
Cardholder Name: (print name) ____________________________
Signature:____________________________
$125 for 6 months: ___ $250 for 1 year: ___ Today's Date: ______
Please Note: Your credit card order will be processed by AIM
Marketing their name will appear on your credit card statement for
the amount of this purchase.
(A $15 fee will be charged for re-processing of charge backs)
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Registration Date: ______ Position Sought: ___________________________
Salary Desired: ____________ Required: ______________ Negotiable: ____________
Name: __________________ Date of Birth: _______
Permanent Mailing Address: __________________ City: ____________ State: ___
Zip: __________ (If outside USA please give detailed mailing instructions below)
___________________________________________________________________________
___________________________________________________________________________
Local Address: __________________ City: ____________ State: ____ Zip: ____________
Phone: ___________ Pager: ___________ Cellular: ____________ Fax: _______________
Day # ________________ Evening # _______________ Other ______________
Availability: Perm. __ Temp. __ Day work __ Freelance __
Sail: __ Power: __ Charter: __ Private: __
Personal: Do you drink? ________ Smoke ________
Male: __ Female: __ Height: ____ Weight: ____ Color Hair: ______ Color eyes: _____
Marital Status: Married: ___ Single: ___ Divorced: ___ Children: ___
Are you willing to be bonded? Yes: __ No: __ Drug Tested? Yes: __ No:__
Have you ever been convicted of a crime? Yes: __ No: __
If so explain: ________________________________________________________________
Health Problems: ____________________________________________________________
Medication required/how often?________________________________________________
Citizenship: Country: ______________ Social security ___________________
Valid Passport # ____________________ Country: _________________
Green Card: _________ Type of Visa: ___________ Country: __________ Exp. date: ____
What language(s) do you speak: ______________________
License(s) held: _____________________________________________________________
Cruising Exp: U.S. Coasts: East __ West __ Gulf __ Pacific __ N.W. __ S.W. __
Bahamas: __ Caribbean __ Mediterranean __ South Pacific __ South America __
North Sea __ Other __________________________________________________________
Total Years As: Captain: ____ Mate: ____ Engineer: ___ Chef/Cook: ___
Steward(ess) ___ Deckhand: ___
Skills: Celestial: ___ Dead Reckoning ___ Coastal Navigation: ___ Radar: ___
Loran C: ___ Sat Nav: ___ GPS: ___
Rigs Sailed: Slp./Cutter ___ Ketch ___ Yawl ___ Schooner ___ Other _________________
Power MY___ Jet Drive ___ SF ___ Commercial ___ Other _________________________
Certified Driver ? ______ Fishing Experience? ____________________________________
Maintenance: Engines:_______________________(Manufacturer) Training: ___________
___________________________________________________________________________
Refrig. Sys. ____________________________(Manufacturer) Training: _______________
___________________________________________________________________________
Generators _____________________________(Manufacturer) Training: ______________
___________________________________________________________________________
Hydraulics ______________________________(Manufacturer) Training: ______________
___________________________________________________________________________
Electrical Exp: None: ___ Moderate: ___ Major: ___ Explain: _______________________
___________________________________________________________________________
Mechanical Ability: Expert: ___ Excellent: ___ Good: ___ Fair: ___
Poor: ___
Yacht Construction Exp: ______________________________________________________
Overseen Rebuild: ___________________________________________________________
Other Yard Exp: _____________________________________________________________
Do you get seasick? __________________________________________________________
Work well under Pressure? ____________________________________________________
Education Level: H.S. ___ College: ___ Years: ____ Major: ________________________
Special Training: ____________________________________________________________
___________________________________________________________________________
Additional Comments: ________________________________________________________
_________________________________________________________________________
How did you find out about Seabreeze Yacht Services: ______________________________
I understand Seabreeze Yacht Services DOES NOT guarantee hire. The cost for page design and listing is NON-REFUNDABLE. We can not be held responsible for any personal expenses incurred prior to hire or acceptance of a position. Misrepresentation of information given above is grounds for dismissal and your page will be removed from this site permanently.
Signature: ______________________________
Date: ____________
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Absolutely
Nautical
To visit our website (click on) http://www.absolutelynautical.com