Employment Application

Position PositionDrillerDriller’s HelperPump TechPump Tech HelperDriverLaborerOther

Name

Phone

Email

Address

Are you over 18 years of age? Are you over 18 years of age? Yes No

Do you have a valid and current Driver's License? Do you have a valid and current Driver's License? Yes No

Do you have a valid and current CDL? Do you have a valid and current CDL? Yes No

Have you EVER had a DWI/ DUI? Have you EVER had a DWI/ DUI? Yes No All drivers in the company must adhere to company specific driving rules. Please notify us if you have had a DUI citation issued to you and the date of that citation.

The date of the citation, and any other details you believe are relevant

If offered employment, you will be subjected to pre-employment drug testing. Will you pass these tests? If offered employment, you will be subjected to pre-employment drug testing. Will you pass these tests? Yes No

Do you have reliable transportation? Do you have reliable transportation? Yes No

Are you willing (and able) to travel for work? Are you willing (and able) to travel for work? Yes No

Previous Employer #1 Name, Phone # or Email address, and a short description of your previous employment.

Previous Employer #2 Name, Phone # or Email address, and a short description of your previous employment.

Personal Reference #1 Name and Phone Number of Personal Reference #3

Personal Reference #2 Name and Phone Number of Personal Reference #3

Personal Reference #3 Name and Phone Number of Personal Reference #3

Qualifications/ Certifications Describe in your own words your experience, qualifications, or certifications that would be helpful for our HR manager to know.

Other Information Provided if you need extra room for your responses.