Driller/Assistant Application Form - AST Enterprises, Inc

Driller/Assistant

Application for Employment

Please fill out the form below completely before submitting.

Personal Information

Last Name

First Name

Middle Name

Date

Street Address

Home Telephone

City, State, Zip

Business Telephone

Have you ever applied for employment with us?

Yes No

If yes: Month and Year

Location

Social Security #

Position Desired

Pay Expected

Apart from absence for religious observance, are you available for full-time work?

Yes No

If not, what hours can you work?

Will you work overtime if asked?

Yes No

Are you legally eligible for employment in the United States?

When will you be available to begin work?

Other special training or skills (languages, machine operation, etc.)

Military Experience

Did you serve in the U.S. Armed Forces?

Yes No

Describe fully.

Describe any training received relevant to the position for which you are applying.

Previous Jobs

All employment for the previous 10 years must be covered below…

Name and Address of Employer

Dates Employed (Month/Year)

Position(s) Held and Duties Performed

Salary

Why did you leave?

Name of Supervisor

Title of Supervisor

Phone Number of Supervisor

May we contact?

Yes No

Reason

+Add More

If they have ever been convicted of a crime

Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court?

Yes No

Describe fully.

MVR Check

AUTHORIZATION TO OBTAIN CONSUMER REPORT OR MOTOR VEHICLE DRIVING REPORT FOR EMPLOYMENT PURPOSES

The undersigned hereby authorizes the ( Name of Employer ) or its insurance agency, SeibertKeck Insurance, or its assigns, to obtain copies of consumer reports, including a motor vehicle report, pertaining to me for employment purposes, and for use in rating and/or underwriting insurance for which the above named employer may apply, and any renewal thereof. I understand that in obtaining such consumer reports, a consumer reporting agency may be used, and I do hereby authorize such use.

Date:

Signed:

Printed Name:

State Licensed in

State Drivers License Number

Date of Birth