Employment

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Application for Employment

Instructions to Applicant
Please answer all questions. If the answer to any question is “no,” “none,” or “not applicable”
do not leave the item blank, but write “no,” “none,” or “N/A.”

Incomplete Applications will NOT be considered.

Position applying for: *	Driller Helper
Full Name *
Address *
City *
State *
Zip Code *
Phone Number *
Alt. Phone Number
Email
Age *
Date of Birth *
Do you possess a valid drivers license? *	Yes No
Do you possess a valid MSHA refresher? *	Yes No Underground Surface
Have you been subject to drug and alcohol testing in the past? *	Yes No
Do you have any medical conditions that would affect job or personal safety in remote locations? ie. diabetes, seizures, stints, asthma, pace makers. *	Yes No
If yes please list.
Have you worked for Spring Valley Drilling before? *	Yes No

Employment History
Past or last Employer
Start Date
End Date
Position Held
Address
Starting Pay
Ending Pay
Reason for Leaving
Phone Number

Previous Employer
Start Date
End Date
Position Held
Address
Staring Pay
Ending Pay
Reason for Leaving
Phone Number

Previous Employer
Start Date
End Date
Position Held
Address
Staring Pay
Ending Pay
Reason for Leaving
Phone Number

Previous Employer
Start Date
End Date
Position Held
Address
Staring Pay
Ending Pay
Reason for Leaving
Phone Number

May we contact your previous employers?	Yes No

Personal References - Required List three persons for references, other than family members, who have knowledge of your work ethic and safety habits. Required Field
Name
Address
Phone Number

Name
Address
Phone Number

Name
Address
Phone Number

To Be Read and Signed by Applicant It is agreed and understood that any misrepresentations given on this application shall be considered an act of dishonesty. It is agreed and understood that the motor carrier or his agent may investigate the applicant’s background to ascertain any and all information of concern to the applicant’s record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such additional information and complete such examination as may be required to complete my application file. It is agreed and understood that this Application in no way obligates Spring Valley Drilling Inc. to employ or hire the applicant. It is agreed and understood that if qualified and hired, I may be on a probationary period during which I may be disqualified without recourse. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Typing name below implies the same as a signature.
Signature
Date
Please click submit button one time only.