ROC SERVICE COMPANY, LLC.
Employment Application
APPLICANT INFORMATION
Name
*
First Name
Middle Initial
Last Name
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
*
Format: (000) 000-0000.
E-mail Address
*
example@example.com
Date Available
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Social Security No.
*
Driver's License No.
Driver's License State Issued
CDL
YES
NO
Referred to ROC by
Desired Salary
Position Applied for
Are you willing to relocate to any ROC location?
*
YES
NO
Are you a citizen of the United States?
*
YES
NO
If no, are you authorized to work in the U.S.?
*
YES
NO
Have you ever worked for ROC Service Company, LLC?
*
YES
NO
If yes, provide dates
Have you ever been convicted of a crime?
*
YES
NO
If yes, explain
EDUCATION
High School
Address
From
To
Did you graduate?
YES
NO
Degree
College
Address
From
To
Did you graduate?
YES
NO
Degree
Other
Address
rom
To
Did you graduate?
YES
NO
Degree
WORK RELATED REFERENCES
Please list three professional references.
Reference #1 Full Name
Relationship
Company
Phone
Format: (000) 000-0000.
Address
Full Name
Relationship
Company
Phone
Format: (000) 000-0000.
Address
Reference #2 Full Name
Relationship
Company
Phone
Format: (000) 000-0000.
Address
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PREVIOUS EMPLOYMENT
Company #1
Phone
Format: (000) 000-0000.
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
Company #2
Phone
Format: (000) 000-0000.
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
Company #3
Phone
Format: (000) 000-0000.
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
MILITARY SERVICE
Branch
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Rank at Discharge
Type of Discharge
If other than honorable, explain
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. Should I be considered for employment, I agree and consent to verification of references and previous employment as well as MVR/criminal background and drug screening.
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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ROC SERVICE COMPANY, LLC.
Employment Application
I HAVE PREVIOUS EXPERIENCE WITH:
Please list any additional experience
Electrical
YES
NO
Roustabout
YES
NO
Flowback
YES
NO
Heavy Hauling
YES
NO
Mechanic
YES
NO
Heavy Equipment
YES
NO
Backhoe
YES
NO
Hydro-Excavator
YES
NO
Welding
YES
NO
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ROC Service Company, LLC
Authorization and Consent for Release of Information Please read carefully
Please Print
Employee Name:
*
Address:
*
City State Zip:
*
DL #:
State of Issue:
SS #:
*
Date of Birth:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Motor Vehicle Reports
Driving records will be obtained as part of the employee evaluation process. MVR's will be checked prior to employment, annually and randomly thereafter.
The report will be used to assess insurability as defined by the ROC Service Company, LLC insurance carrier.
Drug Screen
ROC Service Company, LLC requires applicants being considered for employment to undergo drug and/or alcohol testing. ROC Service Company, LLC has a no tolerance policy and all employees are subject to random testing.
I hereby authorize a Motor Vehicle Report as deemed appropriate to evaluate my insurability for purposes concerning the driving operation of company vehicles. I willingly agree to drug and/or alcohol testing and understand the results will determine employment. I hereby authorize any laboratory, physician, or medical professional retained by ROC Service Company, LLC to conduct such testing and to provide the results to ROC Service Company, LLC. I release ROC Service Company, LLC and any of their third party providers from any liability regarding the results.
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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ROC Service Company, LLC ("ROC Service Company")
DISCLOSURE AND AUTHORIZATION – Please read carefully
This is to inform you that as a part of ROC Service Company's procedure for processing your employment application, or for otherwise determining your eligibility for a position with our Company, a consumer report/investigative consumer report may be obtained for employment purposes. This inquiry may include information as to your education, employment history, criminal record, character, general reputation, personal characteristics, and mode of living, whichever may be applicable. You have the right to make a written request within a reasonable period of time to obtain information regarding the nature and scope of the investigation from the vendor utilized by ROC Service Company. If you wish to obtain such information, please contact HireRight at 866-521-6995 for further information concerning the nature of scope of the investigation.
By signing your name below, you authorize ROC Service Company to procure the consumer report/investigative consumer report described in the paragraph directly above. Further, by signing this form, you authorize ROC Service Company, now and at anytime in the future, to obtain or cause to be obtained a consumer report/investigative consumer report for employment purposes. This authorization shall remain in effect and serve as continuing authorization for ROC Service Company to obtain a consumer report/investigative consumer report for employment purposes at any time during your employment, should you be hired.
Before any adverse action is taken, based in whole or in part on the information contained in a consumer report/investigative consumer report, you will be provided a copy of the report, the name, address and telephone number of the reporting agency, a summary of your rights under the Fair Credit Reporting Act, as well as additional information on your rights under the law.
Print Applicant Name
*
Signature of Applicant
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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