Immediate Starting Ending Supervisor Compensation Compensation Do you have a Driver’s License? Yes No If so, provide Driver's License Number: State of Issue: Expiration Date: What is your means of transportation to work? Have you had any motor vehicle accidents or had your license suspended during the past Yes No five (5) years? If so, how many occurrences? _____________ Have you had any moving violations during the past three (3) years? Yes No If so, how many? ________________________ ADDITIONAL INFORMATION Are you a veteran of the United States Military? Yes No Yes If yes, did you receive an Honorable Date Received No Discharge? If hired, can you provide proof or your legal right to work in the United States? Yes No Have you reviewed essential functions and duties of the job for which you are applying? Yes No (Please obtain them from Wellbore’s website or ask for a copy, if you do not have them.) Are you able to perform the essential functions and duties of the job for you are applying Yes No with or without reasonable accommodation? Do you have any active/binding non-solicitation or non-competition agreements in place with current or former employers? Yes No You must not take any information, contacts, catalogs, brochures, or physical or electronic property from prior employers to Wellbore Fishing & Rental Tools LLC (no matter how Yes No relevant or irrelevant it may seem). Will you comply? Have you ever failed or refused a Drug or Alcohol Test? Yes No If so, provide the date and entity that required the test: Have you been convicted of any criminal offense? (including, but not limited to DUI, DWI or Yes No any major or minor offense of any nature.) (Conviction will not necessarily disqualify an applicant from employment. Each instance and explanation will be considered in relation to the position for which you are applying.) If yes, provide a complete explanation for each conviction. Use the reverse side of page if additional space is needed.
Immediate Supervisor Starting Compensation Ending Compensation ADDITIONAL INFORMATION Do you have a Driver’s License? Yes No If so, provide Driver's License Number: State of Issue: Expiration Date: What is your means of transportation to work? Have you had any motor vehicle accidents or had your license suspended during the past five (5) years? If so, how many occurrences? _____________ Yes No Have you had any moving violations during the past three (3) years? If so, how many? ________________________ Yes No Are you a veteran of the United States Military? Yes No If yes, did you receive an Honorable Discharge? Yes No Date Received If hired, can you provide proof or your legal right to work in the United States? Yes No Have you reviewed essential functions and duties of the job for which you are applying? (Please obtain them from Wellbore’s website or ask for a copy, if you do not have them.) Yes No Are you able to perform the essential functions and duties of the job for you are applying with or without reasonable accommodation? Yes No Do you have any active/binding non-solicitation or non-competition agreements in place with current or former employers? You must not take any information, contacts, catalogs, brochures, or physical or electronic property from prior employers to Wellbore Fishing & Rental Tools LLC (no matter how relevant or irrelevant it may seem). Will you comply? Yes No Yes No Have you ever failed or refused a Drug or Alcohol Test? If so, provide the date and entity that required the test: Yes No Have you been convicted of any criminal offense? (including, but not limited to DUI, DWI or any major or minor offense of any nature.) (Conviction will not necessarily disqualify an applicant from employment. Each instance and explanation will be considered in relation to the position for which you are applying.) Yes No If yes, provide a complete explanation for each conviction. Use the reverse side of page if additional space is needed.
Emp%20Application-%20WFRT.12-12-12.docx