OR/CA Application

Employment History

Please print legibly and complete all fields. Start with the most current employer first.Explain gaps in employment in the comments section
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor
May we contact them for a reference

YesNo
Phone No.
Please enter a valid phone number.
Starting Date

MonthDayYear
Date
Ending Date

MonthDayYear
Date
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor
May we contact them for a reference

YesNo
Phone No.
Please enter a valid phone number.
Starting Date

MonthDayYear
Date
Ending Date

MonthDayYear
Date
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor
May we contact them for a reference

YesNo
Phone No.
Please enter a valid phone number.
Starting Date

MonthDayYear
Date
Ending Date

MonthDayYear
Date
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company

Educational Background
Highest Level of Education
Ex: High School Diploma, Bachelor's Degree, etc.
Name of School
Years Completed
Did you graduate?

YesNo
References

List the name and phone number of three businesses or references that are NOT related to you and are NOT previous supervisors.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.

Additional Information

Your background and work history will be discussed with you if you are granted an interview. You are required to answer all the below questions.
1. Please read this over carefully and sign your applicants below

The answers to the questions contained in this application are true and complete. I understand that incorrect or misleading information is cause for rejection of this application or dismissal from a job if I have been employed. I grant permission to the employers to investigate my references to provide any information the company deems appropriate. I understand that I will have a right to a written request concerning the nature and scope of such investigation inquiry.

As part of the review of your application, we may view and/or access publicly available information about you, including information publicly available on the internet, that is job-related and consistent with the merit system principles and prohibited personnel practices set forth in the Civil Service Reform Act, 5 U.S.C. 2301, 2302. No information from any source may be used to discriminate for or against an applicant based on race, color, national origin, gender, age, political affiliation, religion, disability, marital status, sexual orientation, gender identity, genetic information, status as a parent, membership, or non-membership in an employee organization.

In consideration of my employment, I agree that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the company or myself.

I understand I will need to pass a screening for drug usage before being hired by the company.
Signature*

Clear
Date*

MonthDayYear
Date
Driver's License State *
Birth Date*

MonthDayYear
Date
Social Security No. *
Gender*

MaleFemalePrefer not to answer
Signature*

Clear
* FOR ARIZONA APPLICANTS ONLY *

If applying for the Oregon or California office, please leave this page blank and proceed with the application. Arizona applicants are required to complete this section.
Have you been convicted of a felony?

YesNo
If yes, describe in full: A conviction will not necessarily bar you from employment.
LANGUAGE FOR EMPLOYMENT APPLICATION TO COMPLY WITH AMENDMENTS TO THE CRIMINAL IDENTIFICATION ACT AND AMENDMENTS TO THE JUVENILE COURT ACT:

(Note to the applicant: In keeping with applicable law, you should not disclose conviction information involving records of juvenile, adult, or other convictions that have been ordered by a court to be sealed or expunged. Additionally, you should not disclose records of juvenile, adult, or other arrests that have not resulted in convictions (including, but not limited to, those that have been ordered by a court to be sealed or expunged)).

I hereby give you permission to contact the employers listed on the previous page for any relevant information.
Signature

Clear

Authorization to Obtain Personal Information

In compliance with public law 91-508 (the Fair Credit Reporting Act), as amended by Law 104-208 (the Consumers Credit Reform Act) and applicable State Law, this notice is to inform you that a Motor Vehicle Report may be obtained in connection with your application for employment or current employment. If obtained, the Motor Vehicle Report may be used in making decisions concerning your application for employment and/or employment status with Yellow Jacket Drilling or our affiliate companies. In addition, a limited inquiry will be made through the FMCSA (Federal Motor Carrier Safety Administration) Drug & Alcohol Clearinghouse for all CDL holders, to determine whether drug or alcohol violation information exists about you in the Clearinghouse. You further understand that if you refuse to provide consent for YJD to conduct a limited query of the Clearinghouse, YJD must prohibit you from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.By signing below, you authorize Yellow Jacket Drilling to obtain these reports on you through third parties. You agree to hold harmless from any wrongdoing any third party who provides this information to Yellow Jacket Drilling for the purposes of considering you for employment. You also acknowledge and certify that you have been given a copy of this written notification that a Motor Vehicle Report may be obtained by you.
Name

First NameLast Name
Driver's License #
Driver's License State
Birth Date

MonthDayYear
Date
Social Security #
Gender

MaleFemalePrefer not to answer
Signature

Clear
Should be Empty:

Employment History

Educational Background

References

Additional Information

Authorization to Obtain Personal Information