Crew Application

Captain Larry Mahan
26 Redmond Ave.
N. Reading ,MA. 01864

1-508-428-8728
www.larinda.com

Crew Application

Name :			Date :
Address :
City/Town :			State :	Zip :
Phone :			Alternative Phone :
Email :	SSN :		Birthdate :
Emergency Phone & Contact Person :
Highest Education :		Last School :
Most Recent Job :
Supervisor :		Phone :
Boating Experience :

Certificates (CPR) Lifeguard, USCG,etc. :

Please provide three character references with names, addresses, phone numbers and how you are related to them.
Name	Address	Phone	Relation
1.
2.
3.

Are you on any medications? If so list medications and doctor contact :

How did you learn about the opportunities on the Larinda?

Why would you like to work on Larinda?


Attached is my completed NIDA 5 Chemical Drug Test that is required by the Coast Guard for all crew members. This will be done at my expense.
Sailing and living aboard a ship can be dangerous. The undersigned is willing to accept the risks involved. By signing this application, I understand that Wolverine Motor Works Shipyard,LLC, (W), Schooner Larinda, (L),and/or Lawrence Mahan, (M), assume no responsibility for any injury suffered by me in connection with work or activities as a crew. If I am accepted as crew, neither I, or my heirs, administrators, executors and assigns will institute, nor aid in the institution of any action or law or otherwise against W,L or M on account of any injury to me or my property resulting from this work or activities; and I, for myself and my heirs, administrators, executors and assigns herewith release W,L or M, against all claims for personal injury to me or loss of and damage to my property arising from my activities as crew. Also, I understand that this a volunteer position and the only remuneration is berth and board. Additionally, I realize that I must read the crew handbook upon boarding Larinda and sign that I accept all printed regulations and rules.

Sealed as an instrument this		day of	,2001

Parent or Guardian (18 or under)


Notary Signature:

Crew Signature:

Date:

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