the great lakes group

For Great Lakes: ATTN: Human Resources 4500 Division Avenue Cleveland, OH 44102-2228 (216) 621-4854

For Puerto Rico: ATTN: Human Resources Pier 15 Calle Miraflores Esq. Villa Verde San Juan, PR 00907 (787) 722-1500

INSTRUCTIONS: This application (Parts I, II, III and IV as applicable) for a Conditional Job Offer, must be completed in its entirety, and submitted with resume and required documentation (as indicated) to be considered for employment. Incomplete applications will not be considered. The Application consists of: Part I (to be completed by all applicants); Part II and Part III (to be completed by applicants for Vessel Positions

Afloat and Ashore (e.g. tug crews, shipyard employees, and Part IV (OPTIONAL), (to be completed by veterans only)

The Company may ask disability-related questions; require medical examinations and require submission of further documentation and information from an applicant after the applicant has been given a Conditional Job Offer. Upon receipt and review of requested submissions, documentation, and information, to the satisfaction of the Company, the Company may make a Conditional Job Offer to the applicant, and require an interview, but the Company is under no obligation to do so. Applications are considered active for 45 days, at which point applicants not hired must reapply. Completeness and neatness of this application will be used in considering suitability of applicant for the position applied for. If information is not applicable, then write "N/A". DO NOT leave any blanks. DO NOT write in the shaded areas.

Equal Opportunity/Affirmative Action Employer We ensure that all individuals have an equal opportunity for employment, without regard to race, color, religion, sex, national origin, disability or status as a veteran. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Our company Affirmative Action Program refers to our aggressive recruitment programs, mentoring, training, and family programs that work to recruit and retain qualified individuals. Equal access to employment services and programs are available to all persons. Those applicants requiring reasonable accommodations to the application and/or interview process should notify the Company personnel representative at the address shown above.

Employment Application For a

Conditional Job Offer

Shipyard and Vessel Personnel

(Directly affect safety or potentially dangerous)

Part I 1. Date of Application 2. Name (Month) (Date) (Year)

(First)

(M.I.)

(Maiden-Optional)

(Last)

3. Social Security Number 4. Home Telephone Number (including area code)

5. E-Mail Address

6. Mobile or Other Telephone Number where you can be reached (including area code)

7. Driver's License No. 10. Emergency Contact and Relationship to you

7(a) State of Issue (Contact) 7(b) Expiration Date (Month, Day, Year) (Relationship) 8. Are you a U.S. Citizen Yes No 11. Emergency Contacts Telephone Number (including area code)

9. 8(a) If No, Do you have a Current Work Visa

Yes No

8(b) If Yes, Country of Issue 12. Second Emergency Contacts Telephone Number (including area code)

8(c) Expiration Date (Month, Day, Year)

9. Do You Have a Passport? Yes No 13. Emergency Contacts E-Mail Address 9(a) If so, Expiration Date (Month, Day, Year)

The Great Lakes Group Revised 5/2012

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14. Birth Place: (City) (State) (Country)

15. Present Mailing Address Street Apartment Number

City State ZIP Code 16. Permanent Mailing Address (Indicate "same" if same as block 15.) Street Apartment Number

City State ZIP Code

17. Date Available to Start Work

Check here, if immediately available, or enter date: Month Day Year

18. Which Company are you applying to? (Check all that apply)

19. Location Preference (Check all that apply)

20. Which position are you applying for? (Check all that apply)

The Great Lakes Towing Company

Puerto Rico Towing & Barge Co. SM

Soo Linehandling Services, Inc.

Other (Specify)

___________________

Cleveland, OH (Hqtrs.)

Great Lakes Ports

Sault Ste. Marie, MI

If specific port(s) are desired, specify: __________________

Other (Specify) __________________

(a) Vessel Afloat (b) Vessel Ashore (c) Office Position

Captain Engineer Deckhand/Acting

Engineer Deckhand Captain - Alternate Engineer - Alternate Other (Specify)

________________

Port Captain Port Engineer Shipyard

Employee Yardman Other (Specify)

_________________

Accounting General Admin Engineering Operations Sales & Marketing Secretarial Other (Specify)

_______________

(d) Linehandling

Linehandler

21. Education and Training 21(a) High School (Write the name and location of the last high school you attended or where you obtained your GED high school equivalency) Name of High School City State Years Completed (Check)

1 2 3 4

21(b) Did you receive a diploma? Yes No If NO, Did you receive a GED equivalency? Yes No

21(c) Have you ever attended college or graduate school? YES if yes continue to block 21(d) No If NO, go to block 21(g)

21(d) College/University

Name of College/University School City State ZIP Code

Month and Year Attended Number of Credit Hours Completed Type of Degree (e.g. BA, MA)

Month and Year of Degree Month Year Semester Quarter Month Year


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21. Education and Training (continued) 21(e) Chief Undergraduate Subjects (Show Major on the first line)

Number of Credit Hours Chief Graduate Subjects (Show Major on the first line)

Number of Credit Hours Semester Quarter Semester Quarter

21(f) If you have completed any other courses or training related to the kind of job(s) you are applying for (business, vocational, trade, Armed Forces) provide information below. Name of School City State ZIP Code

Month and Year Attended Class Room Hours Subject(s)

Training Completed (Check Box) Month Year

Yes No

21(g) If you have completed any other courses or training related to the kind of job(s) you are applying for (business, vocational, trade, Armed Forces) provide information below. Name of School City State ZIP Code Month and Year Attended Class Room

Hours Subject(s) Training Completed

(Check Box) Month Year

Yes No

21(h) If you have completed any other courses or training related to the kind of job(s) you are applying for (business, vocational, trade, Armed Forces) provide information below. Name of School City State ZIP Code



Yes No

21(i) If you have completed any other courses or training related to the kind of job(s) you are applying for (business, vocational, trade, Armed Forces) provide information below. Name of School City State ZIP Code



Yes No

21(j) If you have completed any other courses or training related to the kind of job(s) you are applying for (business, vocational, trade, Armed Forces) provide information below. Name of School City State ZIP Code



Yes No


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22. Employment History

Please start with your most recent job, and list your last four (4) employers or your employers during the past five (5) years. All past five (5) years of employment must be included. Attach additional sheets as necessary. Include military service assignments and volunteer activities. This information must be detailed below. If a resume is attached or has been previously submitted, ONLY include information that IS NOT on the resume. (Make sure you list Employer name with this information) 22(a) Do you authorize the Company to contact your present or last employer regarding your character, qualifications, and record of employment? Yes No A "NO" will not affect the initial evaluation of your qualifications. If it is necessary to contact your present or last employer prior to final selection, you will be notified first. NOTE: If you are applying for a DOT-Regulated position, the Company is required to obtain Drug & Alcohol Testing information prior to employing someone in a safety-sensitive function in accordance with 49CFR40.25

22(b) Name of Present or Last Employer

22(c) Address Street Suite Number

City State ZIP Code

22(d) Present or Last Job Title

22(e) Dates of Present or Last Employment Month Year

To Month Year

22(f) Name of Present or Last Supervisor 22(g) Telephone Number (First) (Last) Area Code Prefix Last 4 Numbers

22(h) Salary History (Present or Last salary held. Must be indicated in order for consideration) Wage (Per Hour, Day, Month, or Year as checked) Per (Check One):

$ Hour Day Month Year 22(i) Duties Performed 22(j) Reason for Leaving


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22. Employment History (continued)

22(k) Do you authorize the Company to contact your present or last employer regarding your character, qualifications, and record of employment? Yes No A "NO" will not affect the initial evaluation of your qualifications. If it is necessary to contact your present or last employer prior to final selection, you will be notified first. NOTE: If you are applying for a DOT-Regulated position, the Company is required to obtain Drug & Alcohol Testing information prior to employing someone in a safety-sensitive function in accordance with 49CFR40.25

22(l) Name of prior Employer

22(m) Address Street Suite Number

City State ZIP Code

22(n) Prior Job Title

22(o) Dates of Prior Employment Month Year

To Month Year

22(p) Name of Prior Supervisor 22(q) Telephone Number (First) (Last) Area Code Prefix Last 4 Numbers

22(r) Salary History (Last salary held) Wage (Per Hour, Day, Month, or Year as checked) Per (Check One):

$ Hour Day Month Year 22(s) Duties Performed 22(t) Reason for Leaving


Page 6

22. Employment History (continued) 22(u) Do you authorize the Company to contact your present or last employer regarding your character, qualifications, and record of employment? Yes No A "NO" will not affect the initial evaluation of your qualifications. If it is necessary to contact your present or last employer prior to final selection, you will be notified first. NOTE: If you are applying for a DOT-Regulated position, the Company is required to obtain Drug & Alcohol Testing information prior to employing someone in a safety-sensitive function in accordance with 49CFR40.25 22(v) Name of prior Employer

22(w) Address Street Suite Number

City State ZIP Code

22(x) Prior Job Title

22(y) Dates of Prior Employment Month Year

To Month Year

22(z) Name of Prior Supervisor 23(aa) Telephone Number (First) (Last) Area Code Prefix Last 4 Numbers

22(bb) Salary History (Last salary held)

Wage (Per Hour, Day, Month, or Year as checked) Per (Check One):

$ Hour Day Month Year

22(cc) Duties Performed

22(dd) Reason for Leaving


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22. Employment History (continued)

22(ee) Do you authorize the Company to contact your present or last employer regarding your character, qualifications, and record of employment? Yes No A "NO" will not affect the initial evaluation of your qualifications. If it is necessary to contact your present or last employer prior to final selection, you will be notified first. NOTE: If you are applying for a DOT-Regulated position, the Company is required to obtain Drug & Alcohol Testing information prior to employing someone in a safety-sensitive function in accordance with 49CFR40.25

22(ff) Name of prior Employer

22(gg) Address Street Suite Number

City State ZIP Code

22(hh) Prior Job Title

22(ii) Dates of Prior Employment Month Year

To Month Year

22(jj) Name of Prior Supervisor 22(kk) Telephone Number (First) (Last) Area Code Prefix Last 4 Numbers

22(ll) Salary History (Last salary held) Wage (Per Hour, Day, Month, or Year as checked) Per (Check One):

$ Hour Day Month Year

22(mm) Duties Performed

22(nn) Reason for Leaving


Page 8

23. Professional References (List three [3] persons not listed in blocks 22(f), 22(p), 22(z), or 22(jj) who are not related to you, and who are familiar with you)

23(a) Name 23(b) Telephone Number

(First) (Last) Area Code Prefix Last 4 Numbers

May we contact? Yes No

23(c) Address

Street Suite Number

City State ZIP Code

23(d) Nature of association with you

23(e) Name 23(f) Telephone Number (First) (Last) Area Code Prefix Last 4 Numbers


23(g) Address Street Suite Number

City State ZIP Code

23(h) Nature of association with you

23(i) Name 23(j) Telephone Number (First) (Last) Area Code Prefix Last 4 Numbers


23(k) Address

Street Suite Number

City State ZIP Code

23(l) Nature of association with you


Page 9

24. Professional, Educational or Civic Organizations (List memberships as indicated. You may exclude those which may disclose your race, color, religion or national origin) 24(a) Name of Organization City State


24(b) Type of Organization

24(c) Nature of Membership

24(d) Dates of Membership: Month & Year Month & Year TO

24(e) Name of Organization City State May we contact?

Yes No

24(f) Type of Organization

24(g) Nature of Membership

24(h) Dates of Membership: Month & Year Month & Year TO

24(i) Name of Organization City State May we contact?

Yes No

24(j) Type of Organization

24(k) Nature of Membership

24(l) Dates of Membership: Month & Year Month & Year TO

25. Active Military Service

25(a) Have you served in the United States Military Service? (If your only active duty was training in the Reserves or National Guard, answer "NO". Yes No If "YES" See attached Supplemental Part IV (Optional) - Special Notice to Covered Veterans 25(b) Did you retire? Yes No 25(c) Were you discharged from the military service under honorable conditions? (if your discharge was changed to "honorable" or "general" by a Discharge Review Board, answer "YES". If you receive a clemency discharge, answer "NO".) If "NO", provide the date and type of discharge you received below: Yes No

Month Day Year Type of Discharge

25(d) If last employment was military service, attach copies of DOD Form DD-214 and, at the applicants option, attach your last three (3) performance evaluations prior to discharge.


Page 10

26. Referral Information

26(a) How did you hear about the Company? (Check all that apply)

Newspaper ad Friend Employee Union Website Other (Specify)____________________________________

26(b) Were you referred by someone? (Check Box)

Yes No

If yes, by whom?

Name

(First)

(Last)

26(c) May we contact them for reference? Yes No

26(d) Have you ever applied to, or worked for a Company in the Great Lakes Group of Companies before? Yes No

If yes, name of Company and when?

Name of Company Date Month Day Year

27. Additional Questions

NOTE: It is important that you give complete and truthful answers to questions below. If you answer "YES" to any of them, provide your explanation(s) in block 27(g). Include convictions resulting from a plea of nolo contenders (no contest). Omit: (1) traffic fines of $100.00 or less; (2) any violation of law committed before your 16th birthday; (3) any violation of law committed before your 18th birthday, if finally decided in juvenile court or under a Youth Offender law; (4) any violation of law aside under the Federal Youth Corrections Act or similar state law; (5) any conviction whose record was expunged under Federal or state law. We will consider the date, facts, and circumstances of each event you list. In most cases you can still be considered for employment. However, if you fail to tell the truth or fail to list all relevant events or circumstances, this may be grounds for not hiring you, or for firing you after you begin work

27(a) During the last five (5) years, were you fired from any job for any reason, did you quit after being told you would be fired, or did you leave by mutual agreement because of specific problems? Yes No

27(b) Have you ever been convicted of, or forfeited collateral for any felony violation? (Generally, a felony is defined as any violation of law punishable by imprisonment of longer than one (1) year, except for violations called misdemeanors under State law which are punishable by imprisonment of two (2) years or less). Yes No

27(c) Have you ever been convicted, or forfeited collateral for any firearms or explosives violation? Yes No

27(d) Are you now under charges for any violation of law? Yes No

27(e) During the last five (5) years have you forfeited collateral, been convicted, been imprisoned, been on probation, or been on parole? Do not include violations reported in 27(b), 27(c), or 27(d), above. Yes No

27(f) Have you ever been convicted by a military court martial? If no military service, answer "NO". Yes No

27(g) If "YES" in block 27(a): Explain for each job the problem(s) and your reason(s) for leaving. Give the employer's name and address. If "YES" in blocks 27(b) through 27(f): Explain each violation. Give place of occurrence and name/address of police or court involved.

Item No. Month & Year Explanation Mailing Address

(Name of employer, Police, Court or Agency)




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28. Representations

28(a) Attendance: The Company is a service provider and employee attendance is critical to meet customer service demands.

(i) Are you able to meet the Company's attendance requirements? Yes No

(ii) How many days, other than vacation days, were you absent from your last job? Less than 5 6-10 More than 10

(iii) How many Mondays or Fridays were you absent last year on leave other than approved vacation leave? Number of Mondays _______________ Number of Fridays ___________________

(iv) Do you have any objection to working overtime if necessary? Yes No

28(b) Illegal Drug Use / Medical History:

(i) Have you ever used illegal drugs? Yes No

(ii) Have you used illegal drugs within the last six (6) months? Yes No If yes, when was the last time you used illegal drugs?

(ii) Have you ever been convicted for driving under the influence of illegal drugs or alcohol? Yes No

28(c) General Employment Information

(i) Can you travel if required by this position? Yes No

(ii) Can you submit proof of legal employment authorization and identity as required by governmental authorities? Yes No

(iii) Are you under eighteen (18) years of age? Yes No

(iv) Can you perform any or all job functions for the position applied for, with or without reasonable accommodation? Yes No


Page 12

29. Certifications

29(a) I understand that the Company's Policy on Alcohol, Drugs and Controlled Substances requires Chemical Testing for employees as listed below. I am willing to participate in the required Pre-Employment Chemical Test and, if hired, to comply with the aforementioned Company policy.

I. Vessel Employees Afloat: Pre-Employment, Periodic, Random, Reasonable Cause, Post-Accident Testing.

a. Any person, tugman, or crew member engaged or employed on board a Company tug, barge, vessel, or equipment acting under the authority of a license, certificate of registry, or merchant mariner's document, whether or not a member of the Company tug's crew;

b. Any person employed shore side as an employee or supervisor, who, by virtue of his or her shore

side position, may be engaged or employed on board a Company tug acting under authority of a license, certificate of registry, or merchant mariner's document, whether or not the employee is a member of the Company tug's crew.

II. Vessel Employees Ashore, Shipyard Employees and Linehandlers: Pre-Employment, Periodic, Random, Reasonable Cause, Post-Accident Testing.

a. Any person engaged in duties which directly affect the safety of a Company tug's navigation or operations, or whose duties involve potentially dangerous and hazardous work that may endanger the safety of either themselves or other employees.

b. All Company shipyard, or other Company maintenance facility employees (excluding

administrative and clerical personnel); c. All other employees who perform repair and maintenance, construction, and reconstruction

duties on board vessels and the dry dock; d. All Soo Linehandling Services, Inc. employees (excluding administrative and clerical personnel);

and Employees, in various ports

III. Administrative (including Management and Clerical) Personnel: Reasonable Cause Testing.

a. All shore side employees performing administrative, management, and clerical duties who are not engaged or employed on board a Company tug, barge, or vessel.

b. Any person engaged in duties which DO NOT directly affect the safety of a Company tug's

navigation or operations, or whose duties DO NOT involve potentially dangerous work that may endanger the safety of either themselves or other employees.

29(b) I certify that the information provided in this employment application for a Conditional Job Offer (and accompanying resume, or documentation, if any) is true and complete, and I understand that any false or misleading information, misrepresentation or material omission may disqualify me from further consideration for employment or immediate termination of employment, if I am employed, whenever it may be discovered. I agree to immediately notify the Company if I should be convicted of a felony, of any crime involving dishonesty, breach of trust, controlled substances, sexual misconduct, abuse, or violence, while my job application is pending, or during my period of employment if hired.

(a)______ Initial

(b)______ Initial


Page 13

29. Certifications

29(c) I understand that I am authorizing the release of pre-employment information gained through my employment references. This is to allow the Company to verify and, in the Company's discretion, to perform other background investigations to determine my qualification for employment. Further, I understand that the Company, through a separate Company may investigate my academic credentials, prior employment, personal/professional references, credit record, motor vehicle record, and/or criminal record. I understand that a report may include information obtained through personal interview regarding your character, general reputation, personal characteristics, and/or mode of living. I understand that I may make a written request to obtain a description of the nature and scope of any report, which is prepared regarding me. 29(d) I understand that this Application is for a Conditional Job Offer and does not constitute an offer or create a contract of employment. I understand that if an offer of employment is made, and if hired, I am obliged to comply with the Company' current and subsequently adopted policies, including the Company's Employment Manual, the Company's Policy on Alcohol, Drugs and Controlled Substances, and the Company's Responsible Carrier Program Manual. I am also aware that the aforementioned Company Policies on Alcohol, Drugs, and Controlled Substances, among other things, prohibits the use and possession of intoxicants (dangerous drugs and alcohol) on Company property and vessels, and that violation of the Policies will result in disciplinary action, including suspension, and may result in termination of employment. I understand and agree that, if hired, my employment is for no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time, for any reason, with or without notice. Accordingly, either the Company or I can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal law or state law. I understand that no person is authorized to change any of the items mentioned in this employment application for a Conditional Job Offer. 29(e) I understand that if employed in a temporary position, I will not be entitled to health and other benefits afforded employees in permanent positions. 29(f) I understand that it is the Company's policy not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the Americans with Disabilities Act. 29(g) I understand that once I am offered a conditional job offer and I accept, I will be required to provide satisfactory proof of identity and legal work authorization before my initial start date. Failure to submit such proof and/or the Company not being able to confirm legal work authorization through the E-Verify process, my conditional job offer with the company will be provoked. 29(h) I understand that once I am offered a conditional job offer and I accept, a criminal background check will be performed. If I have not been totally honest with the Company on my background, my conditional job offer with the company will be provoked. I represent and warrant that I have read and fully understand the foregoing and that I seek employment under these conditions. Applicants Signature __________________________________________________________________

(c)______ Initial

(d)______ Initial

(e)______ Initial

(f)______ Initial

(g)______ Initial

(h)______ Initial

ADMINISTRATIVE (Including Management and Clerical) STOP HERE UNLESS A VETERAN: If a Veteran - Complete Part IV (Optional)


Page 14

Part II Supplemental Employment Application

To be completed by Applicants seeking Vessel Positions Afloat and Ashore (including Shipyard) Only

(If you are applying for an Office or Linehandling Position listed, DO NOT complete this Part II, unless also applying for a Vessel Position Afloat and/or Ashore)

30. U.S. Coast Guard Licenses and Document Information

30(a) Do you possess a U.S. Coast Guard Merchant Mariner Document? Yes No (If Yes, Complete blocks 30(b), 30(c), and 30(d) below)

30(f) Do you possess a U.S. Coast Guard License as a Captain, Mate, or Engineer? Yes No (If Yes, Complete blocks 30(f), 30(g), and 30(h) below)

30(b) Ratings held and expiration date: (If temporary, so state) 30(f) Licenses held and expiration date:

(Ratings) Month Day Year (Licenses) Month Day Year

30(c) Do you have a life boat endorsement? Yes No

30(d) List all limitations and endorsements listed on the back of your U.S. Coast Guard Merchant Mariners Document below:

30(g) List all limitations and endorsements listed on your U.S. Coast Guard licenses below:

(Limitations and endorsements)

(Limitations and endorsements)

30(h) For licensed Captain/Deck officers: Are you a qualified RADAR observer? Yes No

31. Tug Experience

31(a) Do you have experience with the following type tugs? 31(b) Do you have experience with the following type of tug work?

a. Conventional Single Screw Tugs Yes No b. Conventional Twin Screw Tugs Yes No c. Tractor Tugs Yes No d. Reverse Tractor Tugs Yes No e. Z-Drives Yes No f. Cycloidal Propulsion Yes No g. Other (Specify) ______________________________________ ____________________________________________________________

a. Harbor Docking/Ship assistance Yes No b. Escorting Yes No c. Tug Barge Units Yes No d. Other (Specify) ______________________________________ ____________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________


Page 15

32. For applicants seeking Vessel positions Ashore (e.g. Port Captain, Port Engineer, Shipyard Employee, Yardman), indicate the level of experience you have had with the tools listed in block 34(a) and in performing the duties listed in block 34(b) using the scale below:

SCALE 0 - Indicates that you have not had any training or work experience 2 - Indicates that you have used/performed alone with little

supervision 1 - Indicates that you have trained, but never had work experience 3 - Indicates that you have used/performed and trained or supervised

others

32(a) Use the Scale above to indicate your level of experience with the following tools or equipment:

_____ Pliers _____ Hammer _____ Screwdriver _____ File _____ Chisel _____ Wrench _____ Power Saw _____ Portable Drill _____ Power Shaper _____ Mortiser _____ Router _____ Metal Shears _____ Lathe _____ Jointer _____ Scrapper _____ Power Sprayer _____ Fork Lift

_____ Hand Truck _____ Dolly _____ Power Winch _____ Grease Gun _____ Impact Wrench _____ Soldering Iron _____ Wire Strippers _____ Basic Voltmeter/Ohmmeter _____ Hydraulic Bender _____ Fire Extinguisher _____ Other (Please Specify) _____ _____________________________________________________ _____ _____________________________________________________ _____ _____________________________________________________ _____ _____________________________________________________ _____ _____________________________________________________ _____ _____________________________________________________

32(b) Use the Scale above to indicate your level of experience in performing the following duties:

_____ Installed electrical cable _____ Spliced cable _____ Repaired telephone equipment _____ Repaired electrical equipment & systems on ships _____ Maintained electrical equipment & systems on ships _____ Repaired electric motors _____ Worked in a steam plant _____ Worked in a diesel plant _____ Worked as a machinist or welder _____ Welded to fine tolerances _____ Welded using processes such as brazing, beading, pressure welding, tack welding _____ Worked as a pipefitter _____ Repaired air conditioning equipment _____ Repaired refrigeration equipment _____ Painted metal surfaces (aircraft, ships, automobiles, etc.) _____ Prepared metal surfaces for painting _____ Painted surfaces other than metal (plastic, wood, etc.) _____ Mixed paints, varnishes, stains _____ Climbed ladders _____ Handled heavy loads _____ Worked in high places

_____ Worked with formal supply systems _____ Performed inventory duties _____ Maintained storerooms/stockrooms _____ Maintained stock records _____ Maintained budget records _____ Planned for & ordered stock/parts _____ Planned storage schemes _____ Arranged items stored to allow for maximum use of space & proper issue _____ Stored supplies _____ Worked as an administrative assistant _____ Worked in a payroll office _____ Used instruction manuals _____ Operated computer terminals _____ Operated office machines _____ Other (Please Specify) _____ _____________________________________________________ _____ _____________________________________________________ _____ _____________________________________________________ _____ _____________________________________________________ _____ _____________________________________________________ _____ _____________________________________________________


Page 16

PART II (CONTINUED)

33. For applicants seeking Vessel positions Afloat and Ashore (e.g. Captain, Engineer, Deckhand, Port Captain, Port Engineer, Shipyard Employee, Yardman), indicate the level of experience you have had with the tools listed in block 33(a) and in performing the duties listed in block 33(b) using the scale page 15:

33(a) Use the Scale on page 15 to indicate your level of experience with the following tools or equipment:

_____ Diesel Engines (Main Propulsion) _____ Diesel Engines (Generators and/or small gasoline engines [small boat]) _____ Chipping Hammer (pneumatic) _____ Deck Winches _____ Bow Thruster _____ Pumps _____ Booms _____ Boilers (Main) _____ After Steering Engine _____ Davits _____ Ventilation Systems (HVAC) _____ Fathometer _____ Steering System (Bridge) _____ Main Electrical Switchboard _____ Anchor Windlass

_____ Capstans _____ Automated Bridge Control _____ AC Generators _____ DC Generators _____ Boiler water supply equipment _____ Compressors _____ Collision Avoidance Radar _____ Gyro Compass (Master) _____ Life boats _____ Fire Detector System _____ CO2 Extinguishing System _____ Inert Gas System _____ Global Positioning System (GPS) _____ Others (Please Specify) _____ _____________________________________________________

33(b) Use the Scale on page 15 to indicate your level of experience in performing the following duties:

_____ Operated hydraulic equipment _____ Repaired valves _____ Tied knots _____ Used life-saving equipment _____ Chipped paint _____ Spliced wire rope _____ Spliced other rope (fiber) _____ Operated davits _____ Worked on slippery surfaces _____ Handled lines _____ Maintained engine machinery _____ Took tank soundings _____ Operated valves _____ Lubricated engine equipment _____ Used various lubricants _____ Disassembled engine room equipment _____ Assembled engine room equipment _____ Read electrical meters _____ Read mechanical gauges _____ Cleaned burners _____ Fired oil burners _____ Assembled & disassembled burners _____ Changed & cleaned strainers _____ Operated & maintained burners _____ Transferred fuel between tanks _____ Pumped bilges _____ Steered by Gyro Compass _____ Steered by magnetic compass] _____ Kept vessel on course _____ Used navigational aids _____ Used navigational rules & regulations _____ Operated gas engines _____ Operated diesel engines _____ Packed shafts and bearings _____ Repaired small boat hulls _____ Performed preventive maintenance on engines _____ Gas free engineer certified

_____ Installed hardware & fittings on launches _____ Towed floating equipment with a launch _____ Lubricated deck machinery _____ Operated booms _____ Rigged booms _____ Stood anchor watch _____ Stood gangway watch _____ Stood bridge watch (underway) _____ Stood engineroom watch (in port) _____ Launched life boats _____ Commanded life boars (oars) _____ Tested boiler water _____ Operated lube oil purifier _____ Operated evaporators _____ Operated main throttle _____ Operated remote shut down devices for machinery spaces _____ Operated machine lathe _____ Fabricated parts _____ Service storage batteries _____ Kept deck log _____ Kept engineering log _____ Knowledge of ship trim and stability _____ Cargo storage _____ Slushed standing rigging _____ Lubricated running rigging _____ Serviced damage control lockers and equipment _____ Used all types of firefighting equipment _____ Taken on fuel, lube oil, and water _____ Knowledge of computers - Vessel application _____ Operated computerized cargo systems _____ Other (Please Specify) _____ _____________________________________________________ _____ _____________________________________________________ _____ _____________________________________________________ _____ _____________________________________________________ _____ _____________________________________________________


Page 17

Part II (Last Page)

Indicate training completed in the following areas by checking the appropriate box. In block 34(a) list other maritime training received such as courses in GYRO-COMPASS and RADAR. In block 34(b), list licenses and certificates you hold other than those issued by the U.S. Coast Guard. Certified Swimmer CPR/First Aid RADAR Operation Diver (Shallow Water) Diver (Deep Water

Yes No Yes No Yes No Yes No Yes No

Lifeboatman Radio Operator (FCC) Radio Operator (CB) GYRO-COMPASS GPS

Yes No Yes No Yes No Yes No Yes No

HASWOPR (Date__________) Other (Specify)______________ __________________________ __________________________

Yes No Yes No

34(a) List of other maritime training received: ________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________

34(b) List of licenses and certificates you hold other than those issued by the U.S. Coast Guard: _______________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________

35. On what type of vessels have you served? Tug/Vessel Name Tug/Vessel Type Company Position(s) Held

36. In what geographical areas have you worked? Please list the areas in which you have worked on board the above vessels, including any particularly noteworthy areas (i.e. river systems, difficult docking areas, etc.)

Tug/Vessel Name Tug/Vessel Type Company Geographical Area

37. Have you ever been involved in any USCG-reportable accident? Yes , If yes, explain in blocks 37(a) and 37(b), No 37(a) Date of Accident Type of Accident Accident Details

Month Day Year

(Accident details continued) 37(b) Date of Accident Type of Accident Accident Details

Month Day Year

(Accident details continued)

38. Photocopies (front &back) of documents required to be submitted with application for a Conditional Job Offer, Vessel Afloat & Ashore. 38(a) U.S. Coast Guard Merchant Mariners Document with endorsements as OS, AB, TANKERMAN, etc. 38(b) U.S. Coast Guard Captain, Mate and/or Engineer's License (if held) 38(c) FCC Marine Radio Operator Permit (f held) 38(d) RADAR Observer Certificate (if held and not included as an endorsement on U.S. Coast Guard License)

Applicant's Signature for Vessel Afloat, Vessel Ashore, and Shipyard positions Date of Signature: Month, Date & Year


Page 18

Part III

CONFIDENTIAL DRUG & ALCOHOL TESTING CONSENT TO RELEASE INFORMATION

DOT REGULATION 49 CFR Part 40.25

39. Name (First) (Middle) (Maiden-Optional) (Last)

40. Address Street Apartment Number

City State ZIP Code

41. Social Security Number 42. Home Telephone Number (Including area code)

I hereby authorize my previous employer(s) that are covered by Department of Transportation Drug Testing Regulations (listed below list all employers for the previous 24 months) to release the following information with regard to my chemical testing records to any one of, or to each of, The Great Lakes Group of Companies:

43. Applicant's Signature 44. Date of Signature (Month, Day & Year)

45. Name of prior DOT Employer

45(a) Name of Contact Person (First and Last name) 45(b) Telephone Number (including area code)

45(c) Dates of Prior Employment: Month & Year Month & Year

TO

45(d) Name of prior DOT Employer

45(e) Name of Contact Person (First & Last Name) 45(f) Telephone Number (including area code)

45(g) Dates of Prior Employment: Month & Year Month & Year

TO


Page 19

Part III (Last Page) 45(h) Name of prior DOT Employer

45(i) Name of Contact Person (First & Last) 45(j) Telephone Number (Including area code)

45(k) Dates of Prior Employment: (Month & Year) (Month & Year) TO

45(l) Name of prior DOT Employer

45(m) Name of Contact Person (First & Last) 45(n) Telephone Number (Including area code)

45(o) Dates of Prior Employment: (Month & Year) (Month & Year) TO

45(p) Name of prior DOT Employer

45(q) Name of Contact Person (First & Last) 45(r) Telephone Number (Including area code)

45(s) Dates of Prior Employment: (Month & Year) (Month & Year) TO

45(t) Name of prior DOT Employer

45(u) Name of Contact Person (First & Last) 45(v) Telephone Number (Including area code)

45(w) Dates of Prior Employment: (Month & Year) (Month & Year) TO

45(x) Name of prior DOT Employer

45(y) Name of Contact Person (First & Last) 45(z) Telephone Number (Including area code)

45(aa) Dates of Prior Employment: (Month & Year) (Month & Year) TO


Page 20

Part IV Supplemental Employment Application - (OPTIONAL)

SPECIAL NOTICE TO COVERED VETERANS

Disabled, Other Protected, Armed Forces Special Medal, and Recently Separated Veterans

Government contractors are subject to 38 U.S.C. 4212 of the Covered Veterans Veterans Employment Emphasis under Federal Contracts. Revised law went into effect as of January 7, 2011. This revised law requires that government contractors take affirmative action to employ and advance qualified Covered Veterans in employment. The term Covered Veteran means any of the following veterans:

1. Disabled Veteran: Any veteran that served on active duty in the U.S. military ground, naval, or air services and is entitled to disability compensation (or who but for the receipt of military retired pay would be entitled to disability compensation) under laws administered by the Secretary of Veterans Affairs, or was discharged or released from active duty because of a service-connected disability.

2. Other Protected Veteran: Any veteran who served on active duty in the U.S. military ground, naval, or air service during a war or in a campaign or expedition for which a campaign badge was authorized.

3. Armed Forces Special Medal Veteran: Any veteran who, while serving on active duty in the U.S. military ground, naval, or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 Fed. Reg. 1209).

4. Recently Separated Veteran: Any veteran who served on active duty in the U.S. military, ground, naval or air service during the three-year period beginning on the date of such veterans discharge or release from active duty.

USERRA (The Uniformed Services Employment and Reemployment Rights Act) requires employers to go further than the ADA by making reasonable efforts to assist a veteran who is returning to employment in becoming qualified for a job. The employer must help the veteran become qualified to perform the duties of the position whether or not the veteran has a service-connected disability requiring reasonable accommodation. This could include providing training or retraining for the position. Additionally, reasonable accommodations may be available under USERRA for individuals whose service-connected disabilities may not necessarily meet the ADAs definition of disability. USERRA also applies to all employers, regardless of size. Information on the reemployment rights of uniformed service personnel can be found on DOLs website at www.dol.gov/vets.

If you are a disabled veteran, or have a physical or mental handicap you may volunteer this information which will be treated as confidential. Additionally, not providing this information will not jeopardize or adversely affect your consideration for employment.

If you wish to be identified, please check the appropriate box(es) and sign below. Submission is voluntary

Disabled Veterans Other Protected Veterans Armed Forces Special Medal Veterans Recently Separated Veterans

THE AMERICANS WITH DISABILITIES ACT (ADA) AMENDMENTS ACT OF 2008

Title I of the Americans with Disabilities Act (ADA) prohibits private and state and local government employers with 15 or more employees from discriminating against individuals on the basis of disability. Title I of the ADA also generally requires covered employers to make reasonable accommodations changes in the workplace or in the way things are usually done that provide individuals with disabilities equal employment opportunities. The ADA makes it unlawful to discriminate in employment against a qualified individual with a disability, therefore, providing this information will not jeopardize or adversely affect your consideration for employment. Additionally, not providing this information will not jeopardize or adversely affect your consideration for employment. If you wish to be identified as an individual with a disability, please check: Yes, I am an individual with a disability.

Signature Date of Signature (Month, Day & Year)


Page 21

Employment ApplicationFor a Conditional Job OfferPart I2. Name 1. Date of Application (First) (Month) (Date) (Year)Part IISupplemental Employment ApplicationTo be completed by Applicants seeking Vessel Positions Afloat and Ashore (including Shipyard) OnlyPart IIICONFIDENTIAL DRUG & ALCOHOL TESTINGPart III (Last Page)Supplemental Employment Application - (OPTIONAL)

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