Apply | Tri-State Drilling, LLC

APPLICATION FOR EMPLOYMENT

Position Applying For(Required)

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Please upload a resume below (optional).

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Max. file size: 256 MB.

Name(Required)

Present Address(Required)

Home Phone

Cell Phone

Email(Required)

Are you 18 years of age, or older?(Required)

Yes

If no, Please Explain(Required)

Can you furnish proof that you are eligible to work in the United States?(Required)

Yes

Can you work at any time of the day or week as needed?(Required)

Yes

If no, Please explain(Required)

Can you work overtime?(Required)

Yes

If no, Please explain(Required)

Can you travel for one or more nights in or outside of the state?(Required)

Yes

If no, Please explain(Required)

Have you ever applied for employment with Tri-State Drilling before?(Required)

Yes

If Yes, When and What position?(Required)

Have you worked for Tri-State Drilling before?(Required)

Yes

If yes, Please list dates of employment and reason for leaving:(Required)

Desired Start Date(Required)

Do you have a high school diploma or a GED?(Required)

Yes

Please list any post high school education, certification or training you have:

School Name:

Degree/Certificate Name

Expire Date:

School Name:

Degree/Certificate Name

Expire Date:

Please list your employment history, starting with the most current job. By completing this you grant us permission to contact them:

Employer Name

Employer Address

Employer Phone

Job Title

Supervisor Name

Start Date

End Date

Hidden

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Reason for Leaving

Employer Name

Employer Address

Employer Phone

Job Title

Supervisor Name

Start Date

End Date

Hidden

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Reason for Leaving

Employer Name

Employer Address

Employer Phone

Job Title

Supervisor Name

Start Date

End Date

Hidden

Untitled

Reason for Leaving

REFERENCES: Please list at least three professional references from former employers that you have had a working relationship with and have known a minimum of one year.

Name

Address

Contact Number

May we contact?

Yes

Years known

Name

Address

Contact Number

May we contact?

Yes

Years known

Name

Address

Contact Number

May we contact?

Yes

Years known

Do you plan to work for any other employer or engage in self-employment during your period of employment with the Company?(Required)

Yes

If yes, Please explain(Required)

Are there any employer policies, requirements or terms or conditions of employment which you are unwilling to accept if you are offered employment?(Required)

Yes

If yes, Please explain(Required)

The Company has policies on sexual harassment and equal employment opportunity, policies which require employees to perform all assigned work and mandatory overtime, policies requiring wage or salary deduction authorizations by employees for employer property, solicitation and distribution policies and policies requiring employees to observe all standards of conduct, policies and work rules of the Company. Do you agree, if hired, to comply with these and all other current or subsequently adopted the Company policies and requirements?(Required)

Yes

If no, Please explain(Required)

ACKNOWLEDGMENT: PLEASE READ AND SIGN

By my signature below, I promise that the information provided in this employment application (and any related information provided by me) is true and complete, and I understand that any false or misleading information or significant omissions may disqualify me from further consideration for employment, and may lead to my dismissal from employment, if discovered at a later date, no matter how long I have been employed. I agree to immediately notify the Company if I should be convicted or plead guilty to any crime while my job application is pending, or during my period of employment if hired by the Company. I authorize the Company (the “Employer”) to obtain and/or to provide any and all information and opinion which the Employer elects to obtain, use or provide in connection with my application for employment and/or any employment with the Employer, prior to, during and after my employment. Such information and opinion may be sought from any and all prior employers (except as noted above), schools or other persons or organizations who may have information the Employer deems relevant in connection with my application for employment and during my employment, and may be provided by the Employer in response to any request for information and opinion concerning my employment or my separation from employment with the Employer, to any and all banks or mortgage companies, governmental agencies, insurers, prospective employers or other schools, persons or organizations deemed appropriate for receipt of such information by the Employer. I understand that the Employer may provide any and all information and opinion, which may include, but are not limited to, opinions about my conduct, performance, attendance, or any other aspect of my reputation or character, which may be positive or negative. I agree to hold the Employer (including its principals, employees, agents, consultants, attorneys and insurers) and any such other employer, school, person or organization providing or receiving any such information and opinion, harmless and free of any and all claims or causes of action arising from any such provision or receipt of information and opinion, no matter what its character

Date(Required)

IF YOU WISH TO BE CONSIDERED FOR POSITIONS THAT REQUIRE DRIVING, PLEASE ANSWER ALL BELOW

Do you have a current, valid and unrestricted driver’s license(s)?

Yes

Do you have a CDL License:

Yes

DRIVER EXPERIENCE & QUALIFICATION - Answer the questions in this section only if applying for a driver position.
Please list all Drivers Licenses held in past 3 years:

State

License #

Class

Exp. Date

State

License #

Class

Exp. Date

State

License #

Class

Exp. Date

Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes

Has any license, permit or privilege ever been suspended or revoked?

Yes

Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?

Yes

Write below, or Attach, a statement giving details. Check the following if a statement is attached

Upload the statement

Accepted file types: pdf, png, jpeg, doc, rtf, txt, Max. file size: 256 MB.

Driving Experience

Class of Equipment

Type of Equipment (Van, Tank, Flat)

Month/Year Driven

Approx. Total Miles

Class of Equipment

Type of Equipment (Van, Tank, Flat)

Month/Year Driven

Approx. Total Miles

Class of Equipment

Type of Equipment (Van, Tank, Flat)

Month/Year Driven

Approx. Total Miles

List states operated in during last 5 years

List special courses of training you’ve had that have helped you as a driver

List driving awards (name of award and organization sponsoring)

Accident Review for past 3 years

Date

Nature (Head on, Read-End)

Fatalities

Injuries

Date

Nature (Head on, Read-End)

Fatalities

Injuries

Date

Nature (Head on, Read-End)

Fatalities

Injuries

Traffic Convictions and Forfeitures for the past 3 years (including DWI/DUI, but NOT parking violations)

LOCATION

DATE

CHARGE

PENALTY

LOCATION

DATE

CHARGE

PENALTY

LOCATION

DATE

CHARGE

PENALTY

Please Note: A criminal background search, physical exam, driving history and/or drug screen after an offer of employment has been made, may be required.

Voluntary Equal Employment Opportunity Questionnaire

Name

First Last

Date Applying

Position Applying For

As part of the Company’s ongoing commitment to equal employment opportunity for all applicants, we are required to monitor and report our applicant and hiring processes. Our organization will not discriminate against or harass any employee or applicant for employment because of race, color, creed, religion, national origin, sex, sexual orientation, disability, age, marital status, membership or activity in a local human rights commission, or status with regard to public assistance. To assist us with our reporting, we are asking that you voluntarily self-report by checking the appropriate box below. This information is confidential and voluntary.

I am, (Please Check One)

Male

Female

Please Check One Below

White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa

American Indian or Alaska Native -a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American - A person having origins in any of the black racial groups of Africa.

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Minority – Any person who identifies as being American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or Other Pacific Islander, or in any combination of these identifiers, or someone who identifies as White and as any of the other identifiers.

Please Check One

I am not a Veteran

I am a Disabled Veteran

I am an Armed Forces Service Medal Veteran

I am a Disabled Armed Forces Service Medal Veteran

Other Protected Veteran

I am currently in the National Guard or Reserves

I am a disabled other protected Veteran

Individual with a Disability: any person who has a physical, sensory, or mental impairment which “materially” (Minnesota) or “substantially” (Federal) limits one or more major life activity or has a record of or is regarded as having such an impairment. "Individual with a Disability" does not include an alcohol or drug abuser whose current use of alcohol or drugs renders that individual a direct threat to property or to the safety of others. We will make reasonable accommodations to the physical and mental limitations of an employee or applicant unless such an accommodation would impose an undue hardship on the conduct of the business. Please ask for a Job Description from Human Resources for the job in which you are applying.

If checked, Please explain

APPLICATION FOR EMPLOYMENT

Please list any post high school education, certification or training you have:

Please list your employment history, starting with the most current job. By completing this you grant us permission to contact them:

REFERENCES: Please list at least three professional references from former employers that you have had a working relationship with and have known a minimum of one year.

ACKNOWLEDGMENT: PLEASE READ AND SIGN

IF YOU WISH TO BE CONSIDERED FOR POSITIONS THAT REQUIRE DRIVING, PLEASE ANSWER ALL BELOW

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