| *Last Name:
|
*First Name:
|
| *Street Address:
|
| *City:
|
*State:
|
| *Zip Code:
|
*Telephone Number:
|
| Email:
|
| *Position(s) Applied for:
|
| *Date of Application:
|
Salary Expected:
|
How did you learn about us?:
|
| Are you available immediately ?
Yes
No |
If not, How soon:
|
| If a driver's license is required for the position for which you are applying,
do you have a valid driver's license? |
| Yes
No
|
|
| License Number:
|
License State:
|
| License Class:
A
B
C |
License Expiration:
|
| Do you have adequate transportation to and from work?
Yes
No |
| Have you been cited for a traffic violation of any kind within the last five (5) years?
Yes
No |
(If yes, please give detail below)
|
| Can you travel if a job requires it?
Yes
No |
| Are you over 18 years of age?
Yes
No |
| If hired, can you furnish proof that you are over 18 years of age?
Yes
No |
How many days of work have you missed in the last three (3) years due to reasons other
than paid holidays and vacation:
|
| Number of days:
|
| Have you ever been convicted of a felony within the last seven (7) years
(Conviction will not necessarily disqualify an applicant from employment):
Yes
No |
If yes, please explain:
|
| Are you currently employed?
Yes
No |
| If yes, may we contact your current employer?
Yes
No |
| |
|
| Employment Experience |
|
| Please list the names of your previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time including military service and any period of unemployment. If self-employed, give firm name and supply business references. |
| Present / Last Employer:
|
| Address, City, State :
|
| Phone:
|
Dates Employed (From/To):
|
| Pay: Start $:
|
Final $:
|
| Position/Title:
|
| Reason for leaving:
|
| Last Supervisor:
|
| |
| Employer:
|
| Address, City, State :
|
| Phone:
|
Dates Employed (From/To):
|
| Pay: Start $:
|
Final $:
|
| Position/Title:
|
| Reason for leaving:
|
| Last Supervisor:
|
| |
| Employer:
|
| Address, City, State :
|
| Phone:
|
Dates Employed (From/To):
|
| Pay: Start $:
|
Final $:
|
| Position/Title:
|
| Reason for leaving:
|
| Last Supervisor:
|
| |
| Have you ever been terminated or asked to resign from any job?
Yes
No |
If yes, explain circumstances:
|
Please explain fully any gaps in your employment history:
|
If laid off, give reason:
|
| |
| Education |
|
| Elementary School:
|
| Address:
|
Years Completed:
|
| High School:
|
| Address:
|
|
| Years Completed:
|
Diploma or Degree:
|
| Undergraduate College:
|
| Address:
|
|
| Years Completed:
|
Diploma or Degree:
|
Other (Specify):
|
| |
|
| Specialized Skills and Qualifications |
|
Tell me about your drilling experience - Number of years? -
Type and model of rigs operated (mud, air, sonic, hollow stem, auger)? Type of industry (oil - environmental - mines)?
|
Tell me about your experience with submersible or turbine pumps.
|
| Do you have a welding certification?
Yes
No |
Tell me about your welding experience.
|
| On a scale of 1 to 5, one being able to change your oil and 5 being able to rebuild an engine, how do you rank your mechanical abilities?
1
2
3
4
5 |
What certifications do you have? OSHA - MSHA - HAZWOPER etc.
|
|
| Do you currently have a CDL?
Yes
No
If not, do you have the ability to obtain one?
Yes
No |
| This position involves extensive travel - are you willing to travel?
Yes
No
or relocate?
Yes
No
|
When we call your former employers, what will they tell me about you? Please provide at least one positive and one negative response.
|
| Have you ever been counseled or violated a safety rule?
Yes
No |
If yes, please explain
|
Why do you want to work for WDC?
|
How did you hear about the job opening?
|
Do you know other good people who might be interested in working for WDC?
|
Summarize any other special job-related skills, drilling equipment and related machinery operated,
office equipment operated, computer and software experience, or other skills and information you feel may be helpful to us in considering your application.
|
| |
|
| Character References |
|
| Please list persons who know you well - not previous employers or relatives |
| Name:
|
Occupation:
|
| Address:
|
| Phone:
|
Years known:
|
| |
| Name:
|
Occupation:
|
| Address:
|
| Phone:
|
Years known:
|
| |
| Equal Opportunity Employer |
|
It is the policy of WDC Exploration & Wells to provide equal employment opportunity to all employees and applicants for employment without regard to race, color, religion, sex, national origin, handicap or veteran’s status; or status within any other protected group. Various agencies of the United States government require employers to collect information about applicants. Information requested on this sheet is for purposes of compliance with these record-keeping requirements and to determine recruiting and employment patterns. Such information will in no way affect the decision regarding your application for employment. This sheet will be kept confidential and maintained separately from your application form.
Completion of this section is voluntary and is not a requirement for employment. |
| Race
|
| Gender
Male
Female |
| Regulations issued by the U.S. Department of Labor with respect to handicapped individuals, disabled veterans,
and Vietnam era veterans require that federal contractors provide a self-identification opportunity to applicants for employment. Such self-identification
and any information provided by the applicant is submitted (a) on a voluntary basis, (b) on a confidential basis, (c) for use only in accordance with regulations,
and (d) without subjecting the individual to adverse treatment. If you wish to be identified, please provide any information you wish to submit. If an applicant or employee so identifies him self or her self, the company shall seek the advice of the applicant or employee regarding proper placement and appropriate accommodation. |
Disabled Individual
Yes
No
A person who has a physical or mental impairment that would cause him/her to have difficulty in
securing, retaining, or advancing in a job or a person who has a history of this type of impairment or anyone who is regarded as having such an impairment |
Vietnam Era Veteran
Yes
No
A person who: (1) served on active duty for a period of more than 180 days, any part
of which occurred between August 5, 1964 and May 7, 1975, and was discharged or released with other than a dishonorable discharge and/or (2) was released from
active duty for a service connected disability if any part of such duty was performed during the same period. |
Special Disabled Veteran
Yes
No
A person who: (1) a veteran entitled to compensation (or who but for the receipt of
military retired pay would be entitled to compensation) under laws administered by the Department of Veterans’ Affairs for a disability a) rated at 30 percent or
more or b) rated at 10 or 20 percent in the case of a veteran who has been determined under Section 3106 of Title 38, USC to have a serious employment handicap or
(2) a person who was discharged or released from active duty because of a service connected disability. |
Other Veteran
Yes
No
A person who served in the military, ground, naval or air service of the United States on active duty
during a war or in a campaign or expedition for which a campaign badge has been authorized. To identify the campaigns or expeditions that meet this criterion, contact
the Office of Personnel Management and ask for the OPM VETS guide, Appendix A. |
| |
| Applicant's Statement & Agreement |
|
|
In the event of my employment to a position at
this company, I will comply with all the rules and regulations
of this company. I understand that the Company reserves the right
to require me to submit to a test for the presence of drugs in
my system prior to employment and at any time during my employment,
to the extent permitted by the law. I also understand that any
other offer of employment may be contingent upon the passing of
a physical examination and a test for the presence of alcohol
and/or narcotics in my system, performed by a doctor selected
by the Company. Further, I understand that at any time after I
am hired, the Company may require me to submit to a physical examination
and an alcohol and drug test to the extent permitted by the law.
I consent to the disclosure of the results of physical examinations
and related tests to the Company. I also understand that should
I decline to sign this consent or decline to take any of the above
tests, my application for employment may be rejected or my employment
may be terminated.
I understand that the Company may investigate
my driving record and my criminal record and that an investigative
consumer report may be prepared whereby information is obtained
through personal interviews with neighbors, friends, personal
references, and others with whom I am acquainted. This inquiry
includes information as to my character, general reputation, personal
characteristics, and mode of living. I understand that I have
the right to make a written request within a reasonable period
of time to receive additional detailed information about the nature
and scope of this investigation. I further understand that the
Company may contact my previous employers, and I authorize those
employers to disclose to the Company all records and information
pertinent to my employment with them. In addition to authorizing
the release of any information regarding my employment, I hereby
fully waive any rights or claims I have or may have against my
former employer, their agents, employees, and representatives,
as well as other individuals who release information to the Company,
and release them from any and all liability, claims or damages
that may directly or indirectly result from the use, disclosure,
or release of any such information by any person or party, whether
such information is favorable or unfavorable to me.
I authorize the persons named herein as personal
references to provide the Company with any pertinent information
they may have regarding myself.
I hereby state that all the information that I
provided on this application or any other documents filled out
to connection with my employment, and in any interview is true
and correct. I have withheld nothing that would, if disclosed,
affect this application unfavorably. I understand that if I am
employed and any such information is later found to be false in
any respect, I may be dismissed. I understand if selected for
hire, it will be necessary for me to provide satisfactory evidence
of my identity and legal authority to work in the United States,
and that federal immigration laws require me to complete Form
I-9 in this regard.
If hired, I agree as follows: My employment and
compensation is terminable at will, is for no definite period,
and my employment and compensation may be terminated by the Company
(employer) at any time, without good cause at the option of either
the Company or myself. No implied, or oral, or written agreements
contrary to the express language of this agreement are valid unless
they are in writing signed by the President of the Company. No
supervisor or representative of the Company, other than the President
of the Company has any authority to make any agreements contrary
to the foregoing. This agreement is the entire agreement between
the Company and the employee regarding the right of Company or
employee to terminate employment without good cause, and this
agreement takes place of all prior and contemporaneous agreements,
representations, and understandings of the employee and the Company.
If you have any questions regarding this statement,
please ask a Company representative before agreeing.
|
Do not agree until you have read the above statement & agreement.
I agree
I disagree |
|