EMPLOYMENT APPLICATION FORM EMPLOYMENT APPLICATION FORM APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS Date Last Name First Name Middle Name Present address Present address City State Zip Code How long have you lived at your current address? Phone Number Are you under 18 years of age? YesNo Position applied for: Desired Salary Range/Per Hour: From To Days available to workANYMONTUEWEDTHUFRISATSUN How many hours can you work weekly? Can you work overtime? YesNo Are you aware that working hours will vary due to work schedule demands? YesNo Employment desired: Full-time onlyPart-time onlyFull or Part-time When are you available to start work? TYPE OF SCHOOL High School Name of School City and State Number of Years Completed Diploma Status —Please choose an option—DiplomaGEDDid not Graduate College Name of School City and State Number of Years Completed Major & Degree Trade School/Other Name of School City and State Number of Years Completed Major & Degree Applicant Resume Upload your resume Next Do You Have a Driver's License YesNo Driver’s license number State of issue Expiration Date Type of license OperatorCommercial (CDL)NA Have you had any accidents during the past 3 years? YesNo How Many Have you had any moving violations during the past 3 years? YesNo How Many If moving violations, what was the violation? Please list two references other than relatives or previous employers: Reference 1 Name Telephone Relationship to Applicant Reference 2 Name Telephone Relationship to Applicant An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. BackNext MILITARY Have you ever been in the Armed Forces? YesNo Are you now a member of the National Guard? YesNo Specialty Date Entered Discharge Date Work Experience 1 Name of employer Address City State Zip Code Phone number Name of last supervisor Your last job title Employment Dates From Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year Employment Dates To Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company Work Experience 2 Name of employer Address City State Zip Code Phone number Name of last supervisor Your last job title Employment Dates From Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year Employment Dates To Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company BackNext Work Experience 3 Name of employer Address City State Zip Code Phone number Name of last supervisor Your last job title Employment Dates From Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year Employment Dates To Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company Work Experience 4 Name of employer Address City State Zip Code Phone number Name of last supervisor Your last job title Employment Dates From Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year Employment Dates To Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company May we contact your present employer? YesNo May we contact your past employers? YesNo BackNext PLEASE READ CAREFULLY APPLICATION FORM WAIVER In exchange for the consideration of my job application by CLOUSER DRILLING INC. (hereinafter called “the Company”), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of CLOUSER DRILLING INC, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and CLOUSER DRILLING INC. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract. I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job related physical examinations. I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. I further understand that my employment with the Company shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party. This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications. I consent to the conditions. Back
