Employee Verification 2 | Baranof Courageous

New Employee Forms

Before you begin, make sure you have the necessary documents to complete the I-9 form. You need at least 1 document from List A, or one from List B and one from List C. Read each page, and fill out each field. Submit when done.

Form I-9 requires documents to verify employment authorization. Read a list of acceptable documents. You either need one document from LIST A or a combination of one document from LIST B and one from LIST C.

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I will upload one document from List B and one from List C

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Anti-Harassment Policy

It is the policy of Romanzof Fishing Company, L.L.C. (the “Company”) to provide a work environment that is free from harassment and discrimination. Harassment and discrimination of any sort, including sexual harassment, is unlawful and will not be tolerated. Harassment may result in disciplinary action up to and including termination.

What Is Harassment?

Harassment can take many forms. It may include, but is not limited to: words, comments, suggestive remarks, jokes, pranks, non-verbal pictures or signs, gestures, intimidation, physical contact, or violence. Harassment need not necessarily be sexual in nature to be unlawful.

Sexual harassment may include unwelcome sexual advances, requests for sexual favors, other verbal comments or physical gestures or contact of a sexual nature, when submission to or rejection of this conduct explicitly or implicitly affects an individual's employment, unreasonably interferes with an individual's work performance or creates an intimidating, hostile or offensive work environment. Such conduct may include but is not limited to:

Sexual flirtations, touching, advances, or propositions, repeated unwanted requests for dates;
Verbal comments, unwanted jokes, gestures, offensive words, graphic or suggestive comments about an individual’s dress or body, and unwelcome comments and repartee of a sexual nature;
Sexually degrading words used in describing an individual or act; and/or
Display in the workplace of sexually suggestive objects, images, cartoons, photographs or pictures including but not limited to, offensive electronic communications or voice-mail messages and accessing pornographic images through the internet or email.

The Company specifically prohibits any discrimination, harassment, or retaliation on the basis of an employee's or applicant's race, color, religion, national origin, age, gender/sex, marital status, veteran status, the presence of a disability, sexual orientation, or any characteristic or trait protected by applicable federal, state or local law.

Examples of prohibited forms of other discriminatory conduct include, but are not limited to: memos, letters, cartoons, e-mails or other visual displays of objects, pictures or posters that depict such protected groups or individuals in a derogatory way; or verbal threats or comments, epithets, slurs and jokes that are derogatory with respect to any protected group or individual.

Reporting

If you feel that you have experienced or witnessed harassment or discrimination, you have a responsibility to report the incident immediately to the vessel’s Mate or Captain or to Chuck Hosmer, General Manager. Reports and complaints of harassment and discrimination will be investigated in as impartial and as confidential a manner as possible. However, absolute confidentiality cannot be maintained, is not promised and should not be expected because the Company is required by law to investigate all complaints of unlawful behavior. Employees are required to cooperate in any investigation. In the sole discretion of the Company, after the investigation and depending on the results, a timely resolution of each complaint will be reached. Retaliation or discrimination against any employee for making a good faith complaint or participating in an investigation is strictly prohibited.

Any employee, supervisor or manager found to have engaged in harassment or discriminatory conduct against another employee, guest, customer or visitor will be subject to prompt disciplinary action, up to and including termination of employment. If you are found liable for harassment or discrimination, you may be personally responsible for a monetary judgment or settlement and legal fees and costs associated with your defense. The Company may take additional actions necessary to appropriately correct the situation in its sole discretion.

I have read the above “Anti-Harassment Policy” and by my signature below I acknowledge that I understand and will adhere to the policy as written.

Name(Required)

First Last

Signature(Required)

Today's Date(Required)

M/V BARANOF IS A DRUG FREE WORKPLACE

The Company considers illegal drug use or the misuse of legal drugs and/or alcohol to be a threat to its workplace and to its crewmember’s personal health by seriously impairing a crewmember’s ability to do his or her duties in a safe and efficient manner.

Illegal Drugs Prohibited

Crewmembers shall not use, sell, possess, give away, or be under any influence of illegally obtained drugs while contracted with the Company or on any of its vessels.

Impairment Prohibited

A crewmember shall not report to work when his or her performance or ability to perform his or her duty safely and effectively might be adversely affected by any drugs or alcohol, regardless of whatever that substance is, legal or not.

Substance Abuse Testing

All applicants are subject to pre-placement drug testing.
All crew members are subject to drug and /or alcohol testing in the following situations:
1. Following an on-the-job accident or injury
2. On a random unannounced basis,
3. Prior to returning to work after a drug and alcohol use violation,
4. On a follow-up basis after a drug and alcohol use violation.

Hotline Numbers

These are community provided Drug and Alcohol Consultation Numbers that the Company encourages its crewmembers to contact if they feel that they may have a drug or alcohol related challenge: National Council on Alcoholism and Drug Dependence: 800/NCA-CALL American Council on Alcoholism Helpline: 1-800-527-5344 Alanon (Family Members): 1-800-356-9996 National Council on Alcoholism: 1-800-622-2255 Cocaine Hotline: 1-800-262-2463 24-Hour Alcohol and Drug Hotline (206) 722-3700

Questions

The Company is committed to clarifying questions and assisting crewmembers regarding this policy and program. Each crewmember is encouraged to seek assistance as desired. The Company management maintains an “open door” policy to all of its crewmembers relative to this and all policies and programs.

Name(Required)

First Last

Signature(Required)

Today's Date(Required)

CREWMEMBER DENTAL AGREEMENT

MY LAST VISIT TO THE DENTIST WAS(Required)

I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO VISIT A DENTIST AT LEAST ONCE EACH YEAR FOR EVALUATION, CLEANING AND TREATMENT OF MY TEETH AND GUMS.

I understand that my work aboard the M/V BARANOF (the “Vessel”) may involve long periods of time out at sea. I am aware that no dental support is available on board the Vessel and that there is no resident dentist in Dutch Harbor or in many other Alaskan ports. I thus confirm that it is my responsibility to seek treatment for any dental problems or illnesses at my own expense prior to departure.

I further confirm that all expenses incurred for the treatment of dental illnesses after departure of the Vessel, including but not limited to cavities and decay, fillings, root canal treatment, crowns, tooth loss, deterioration of existing bridges and gum disease, will be my sole responsibility. In the event my Employment Agreement is terminated and/or I depart the Vessel due to a dental illness, I understand that I am not entitled to unearned wages.

I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THIS DENTAL AGREEMENT. I HEREBY RELEASE AND DISCHARGE ROMANZOF FISHING CO. LLC, THE VESSEL, ITS MASTER AND THE CREW, FROM ANY AND ALL CLAIMS RELATING TO DENTAL PROBLEMS AND ILLNESSES NOT RESULTING FROM A REPORTED ACCIDENT DURING MY EMPLOYMENT.

Name(Required)

First Last

Signature(Required)

Today's Date(Required)

AUTHORIZATION TO RELEASE HEALTH CARE INFORMATION

Name(Required)

First Last

Date of Birth(Required)

Social Security Number(Required)

I hereby authorize Romanzof Fisheries Company, LLC and its agents or assigns, to obtain medical records and speak with all medical providers regarding me. I hereby request and authorize all hospitals, clinics, doctors, dentists, psychologists, psychiatrists, therapists, or other health care providers (each a "Health Care Provider") to release all my complete health care file and all health care information which they hold concerning me, including, but not limited to, all medical and dental records, reports, charts, nurse’s notes, prescription records, laboratory and test results, x-rays, and billings, correspondence,, and any documents records, information or materials concerning any treatment, examinations, or other services rendered to me or with respect to my health.

This release applies to all documents or other information and materials concerning my health care with respect to any conditions, illnesses, and/or injuries for which I am now under treatment or for which I have received treatment or been examined for in the past. I specifically authorize the Health Care Provider receiving this form to provide the requested documentation to the requesting party. I hereby waive any rights available to me under 42 USC 290dd-3 and 42 CFR 2.1, et seq., and the Health Insurance Portability and Accountability Act (HIPAA). I understand that once the above information is disclosed, it may be subject to re-disclosure by the recipient and no longer protected by federal privacy laws or regulations. I hereby specifically consent to hold the Health Care Provider and requesting party harmless for their release, receipt, and re-disclosure of the requested records.

I understand that my express consent is required to release any health care information related to testing, diagnosis, and/or treatment for HIV (AIDS virus), sexually transmitted diseases (STDs), psychiatric disorders/mental health, drug and/or alcohol use. The Health Care Provider is hereby specifically authorized to release all health care information related to such diagnoses, testing or treatment.

Revocation: I understand I have the right to revoke this Authorization at any time by giving notice in writing to Romanzof Fishing Company, LLC and Health Care Provider. Such revocation shall be effective upon delivery, excepting only that information released prior to revocation and information necessary for payment purposes.

A copy (including fax) of the signed Authorization is as valid as the original.

Signature(Required)

Today's Date(Required)

This Authorization to Release Health Care Information shall be valid for one year from the indicated date.

Email

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