Full Name
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Position Applied for:
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--- Select Position --- Directional Drilling – Crew Foreman/Lead Directional Drilling – General Laborer Directional Drilling – Operator Locator Geothermal – Rig Foreman Geothermal – Rig Helper Geothermal – Tie-In Foreman Geothermal – Tie-In Helper Geothermal – Tie-In Operator Accounting Assistant
How did you hear about this opportunity?
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Date
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Phone
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Address
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City
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State/Province
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Zip
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Email
Date Available to Start:
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Desired pay rate:
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If you have any limitations on the hours that you can work, please explain:
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If yes, who?
EDUCATION:
High School:
City / State
College Degree (if applicable)
College:
City / State
College Degree (if applicable):
Other
City / State
Other Degree (if applicable):
Previous Employer1
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Phone
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Supervisor
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Address(City/State)
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Job Title
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Job responsibilities & duties
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Start Date
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End Date
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Reason for leaving
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Professional Reference #1:
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Relationship
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Phone
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Professional Reference #2:
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Relationship
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Phone
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Professional Reference #3:
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Relationship
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Phone
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SKILLS & QUALIFICATIONS:
List any skills, course work, certificates, and licenses that you’ve acquired that would be of benefit to you for the position that you are applying for
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DRIVER INFORMATION:
If yes, list the endorsements that you have
When does your current license expire?
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If yes, when does it expire?
DRIVING EXPERIENCE:
Equipment Description
Straight Truck
Type (Van, tank, flat, etc.)
Dates (years)
Approx. total miles
Equipment Description
Tractor & Semi
Type (Van, tank, flat, etc.)
Dates (years)
Approx. total miles
Equipment Description
Other
Type (Van, tank, flat, etc.)
Dates (years)
Approx. total miles
If yes, list the training
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Most recent accident
Description of Accident
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Date
List Injuries
Fatalities?
Most recent accident
Most recent accident
Description of Accident
Date
List Injuries
Fatalities?
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#1
Violation
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City/State
Date
Penalty
2
#2
Violation
City/State
Date
Penalty
ADDITIONAL INFORMATION:
(list any info. about yourself here that you care to add)
Date
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Submit