Pumpco Application Form – Fill Out and Use This PDF

A SUPERIOR ENERGY SERVICES COMPANY

Application for Employment

Conditions of employment are stated at the end of this form. Please read carefully before you sign this application.

(Application must be completed in full even if attaching a resume.) Job applications are considered active for 60 days after which

the applicant must reapply for further consideration

POSITION APPLIED FOR _________________________________________ DATE OF APPLICATION ________________

PERSONAL

PRESENT	STREET CITY STATE ZIP			HOW	HOME TELEPHONE #
ADDRESS				LONG
PREVIOUS	STREET CITY STATE ZIP			HOW	MESSAGE TELEPHONE #
ADDRESS				LONG
IF NO PHONE, HOW MAY WE CONTACT YOU?
HAVE YOU EVER WORKED FOR THE COMPANY OR ANY DIVISIONS OF COMPLETE PRODUCTION SERVICES
BEFORE?
[ ] YES [ ] NO		IF YES, WHERE?	APPROXIMATE DATE: MO/YR.
HAVE YOU EVER APPLIED FOR THE COMPANY OR ANY DIVISIONS OF COMPLETE PRODUCTION SERVICES BEFORE?
[ ] YES [ ] NO		IF YES, WHERE?	APPROXIMATE DATE: MO/YR.

HOW WERE YOU REFERRED:

GENERAL INFORMATION

ONLY U.S. CITIZENS OR ALIENS WHO HAVE A LEGAL RIGHT TO WORK IN THE U.S. ARE ELIGIBLE FOR EMPLOYMENT. CAN YOU, UPON EMPLOYMENT PROVIDE GENUINE DOCUMENTATION ESTABLISHING YOUR IDENTITY AND ELIGIBILITY TO BE LEGALLY EMPLOYED IN THE UNITED STATES? [ ] YES [ ] NO

HAVE YOU EVER BEEN CONVICTED OF A FELONY? [ ] YES [ ] NO

(A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. FACTORS SUCH AS JOB RELATIONS, AGE AND TIME OF THE OFFENSE, SERIOUSNESS AND NATURE OF VIOLATION AND REHABILITATION WILL BE TAKEN INTO ACCOUNT). IF YES, PLEASE EXPLAIN:

HAVE YOU EVER BEEN DISCHARGED FROM ANY EMPLOYMENT OR ASKED TO RESIGN? [ ] YES [ ] NO IF YES, PLEASE EXPLAIN:

_______________________________________________________________________________________________________________________________________

Can you perform the essential functions of the position for which you have applied? [ ] YES [ ] NO If no, please explain:

____________________________________________________________________________________

(If you have any questions about the essential functions, ask the interviewer before answering)

		JOB INTERESTS
Please state type of work preferred		Position(s) desired
Date available for work	Salary desired	Geographical preference(s)	Willing to travel?
			Yes	No

EMPLOYMENT HISTORY

BEGIN WITH YOUR MOST RECENT EMPLOYMENT [1] AND CONTINUE WITH ALL PAST EMPLOYMENT FOR THE LAST 5 YEARS.

(ATTACH ADDITIONAL SHEET IF NECESSARY)

EDUCATION

	EDUCATION	NAME AND ADDRESS OF SCHOOL	MAJOR SUBJECT	CIRCLE LAST	GRADUATED	DEGREE
	TYPE OF SCHOOL			YEAR ATTENDED
	HIGH SCHOOL			9 10 11 12	[ ] YES [ ] NO
	COLLEGE			1 2 3 4	[ ] YES [ ] NO
	COLLEGE			1 2 3 4	[ ] YES [ ] NO
	GRADUATE SCHOOL			1 2 3 4	[ ] YES [ ] NO
	BUSINESS. TRADE OTHER			1 2 3 4	[ ] YES [ ] NO

ADDITIONAL EXPERIENCE OR QUALIFICATIONS

List any other experience, skills or other qualifications including hobbies, which you believe should be considered in evaluating your qualifications for employment.

U.S. MILITARY INFORMATION

REFERENCES

NOTIFICATION AND AGREEMENT

PLEASE READ BEFORE SIGNING

I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE. I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION (OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN OR H0W DISCOVERED.

Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

I hereby certify that all of the facts and information listed on this employment application are true and complete. I understand that any false, incomplete or misleading information given by me on this application is sufficient cause for rejection of this application. I also understand and agree that any such false, incomplete, or misleading information discovered on this application at any time after I am employed may result in dismissal.

If I am offered employment, I understand that such an offer will be conditioned upon satisfactory results of a background investigation and/or Company medical examination or inquiry, including a drug-screening test. I consent to the investigation, physical and drug test.

I hereby authorize the Company to investigate all statements contained in this application, to interview the references and previous employers listed in the application, and to obtain a report from a consumer-reporting agency to be used for employment purposes in accordance with the Fair Credit Reporting Act. I authorize the references and previous employers listed to give the Company all facts, opinions and evaluations concerning my previous employment and any other information they may have, personal or otherwise, and release all such information to the Company, including, but not limited to, any liability or invasion of privacy.

In consideration of my employment, I agree to conform to the company’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company’s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.

I further understand and voluntarily agree as a condition of employment or my continued employment, that I may be requested by the Company to submit to a urinalysis or other drug screen test and that my failure to take such test(s) when requested to do so or unsatisfactory test results will disqualify me from consideration for employment, or if I am then employed, may result in immediate dismissal.

Applicants with felony charges must have the division President’s approval before employment.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

Print Full Name:____________________________________________ Date of Birth:____________________________

Social Security Number: ________________________________

Applicant Signature: ______________________________________ Date: ____________________________

AN EQUAL OPPORTUNITY EMPLOYER