Application for Employment. Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Driver's License Number & Class Are you Authorized to work in the U.S.? * Yes No Type of Work * Full Time Rotation Available Start Date * MM DD YYYY Years of experience in oilfield * 0-1 Year 1-3 Years 3-5 Years 5+ Years Type of oilfield related work? Have you worked in any of the following? (Check all that apply) Roustabout/Yard Hand Pulling Units Snubbing Units Workover Rigs Coil Tubing Slickline Frac Support Cementing Swabbing Wireline Fishing Jobs Top Drive Systms P&A (Plug & Abandonment) What positions have you held on a rig? Roustabout Floorhand Derrickhand Operator Rig Mechanic Toolpusher Driller Consultant List of equipment you've operated or worked with (e.g., tongs, elevators, catheads, power swivels, top drives, pumps, etc). Describe your day-to-day responsibilities on the job: Do you have current PEC/Safeland, H2S, First Aid/CPR, or other training? Yes No List of Certifications Have you ever been involved in a safety incident? Yes No If yes, explain: Previous Employer Company Name Supervisor Dates Employed Reason for leaving Are you willing to travel or relocate? Yes No Do you have experience in extreme weather or remote sites? Yes No Are you mechanically inclined or familiar with rig maintenance? Yes No What do you feel is the most important part of well servicing safety? What are your long-term goals in the oilfield? Have you ever been convicted of a felony or misdemeanor? (Excluding minor traffic violations) Yes No If yes, please explain the natre of the offense, date, and outcome: (Answering 'yes' does not automatically disqualify you. We consider the nature of the offense, job-relatedness, and time passed.) Thank you!