HERCULES OFFSHORE, INC. APPLICATION FOR EMPLOYMENT. Personal Information

Transcription

1 APPLICATION FOR EMPLOYMENT Personal Information Date: Social Security Number: - - Name: (Last) (First) (Middle) (Suffix) Address (Number and Street): County Zip City or Parish State Code Country Home Telephone #: Mobile Phone #: Other Phone # /Type: ( ) ( ) ( ) Personal Address: Are you over 18 years of age? Do you have a current, valid driver s license? Division Interest: Yes No Yes No What kind of position are you applying for? Drilling Liftboats Corporate Full-time Part-time Contract/Temporary Position applying for? Expected Salary: Employment Eligibility: 1. If you are hired by Hercules Offshore, can you submit certification of your right to legally work in the U.S.? Yes No 2. Is your authorization to work contingent on Department of Homeland Security, school or program approval? Yes No 3. If answer to question #2 above is YES, what is the basis of the authorization? Please check all of the predecessor companies (due to acquisition or merger) you previously worked for, dates of employment and reason for leaving: Company Dates of Employment and Reason for Leaving Company Dates of Employment and Reason for Leaving 2R Drilling Parker Drilling APMC Drilling R&B Falcon Blake Drilling Reading and Bates Drilling Cliffs Drilling Seahawk Danos & Curole Sedco-Forex Dixilyn Field Drilling Sonat Offshore Drilling Falcon Drilling Superior Forex TODCO Global Industries The Offshore Company Grace Offshore Transocean Halliburton Transocean ASA Hercules Offshore Transocean Sedco Forex Huthnance Wilrig Laborde Other: Do you have any relatives*, including those by marriage, working at Hercules Offshore? Yes No (*A relative is defined as: spouse, mother, father, stepmother, stepfather, son, daughter, stepson, stepdaughter, brother, sister, stepbrother, stepsister, grandparent, grandchild, niece, nephew, aunt, uncle, in-laws of spouse, mother, father, brother, sister, son, daughter, or any adoption are likewise included in this definition.) (Revised 06/07/11) Page 1 of 5

2 APPLICATION FOR EMPLOYMENT cont d. Referral Source? (Please check one.) Personal Information continued. Advertisement (Type, Date, Location ): Agency Referral (Agency Name): College Recruit (School): Direct Recruit (Contact Name): Employee Referral (Name): Employment Commission (State): Internet (Identify Website): Job Fair (Name, Date, Location): Own Initiative (Identify Method): Other (Identify): Have you ever been convicted of any crime or crimes, either misdemeanors or felonies (other than minor traffic violations)? Also, list any arrests for which you are out on bail or your own recognizance, pending trial. (Such convictions will not exclude you from consideration for employment.) Yes No If Yes, please give dates and explanation: References List two references not related to you that you have known or worked with for at least two years. Name and Occupation Address (City and State) Telephone # Address ( ) ( ) Education and Experience Have you graduated from high school or received a high school equivalency diploma? Yes No If No, circle the highest grade completed: School Name Location (City, State and Country) Credit Hours Completed Type of Degree Received Graduation Date (Month/Day/Year) High School College or University Technical or Business List additional skills, abilities or licenses you possess: List any languages you speak, including level of expertise: fluent, read, write: (Revised 06/07/11) Page 2 of 5

3 APPLICATION FOR EMPLOYMENT cont d. Employment History Beginning with your PRESENT OR MOST RECENT employment experience and working backward, list all positions held which are necessary for determining your eligibility for employment. List all positions (titles) separately; even if with the same employer. Clearly describe the work (duties) you personally performed. You must fill out this application completely even if a resume is being attached. (Start with most recent job) May we contact your current employer/supervisor for a reference? Yes No (Revised 06/07/11) Page 3 of 5

4 APPLICATION FOR EMPLOYMENT cont d. Employment History continued. (Revised 06/07/11) Page 4 of 5

5 APPLICATION FOR EMPLOYMENT cont d. Applicant Statement The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement on this application may result in my dismissal. I further understand that this application is not and is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides to employ me. I understand and agree that my employment, if any, is at-will and can be terminated by either party with or without notice, at any time, for any reason or no reason. No one other than an officer of the Company has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and then only in writing signed by an officer. You are hereby authorized to make any investigation of my personal history and financial and credit record through any investigative or credit agencies or bureaus of your choice. I further understand and acknowledge that I must provide proof of a Current and Valid Driver s License should the position applied for require one. In the event that a Current and Valid Driver s License is not provided, I understand that any offer of employment shall be withdrawn. Signature of Applicant: Date: (Revised 06/07/11) Page 5 of 5

6 Refer a New HERO Program Form Applicant s Name: Referral Date: Referring Hercules Employee: (Print One Name Only) The applicant must have listed the referring employee s name on the employment application to be eligible for the payout. I have read and understand Hercules Offshore s Refer a New HERO Program policy. Applicant s Signature Date **Please forward this form along with your Employment Application to Human Resources for processing.** INTERNAL USE ONLY From: Payroll Human Resources Charge Award Date: Award Amount:

7 AUTHORIZATION FORM FOR CONSUMER REPORTS In connection with your application for employment (including contract for services), understand that consumer reports or investigative consumer reports which may contain public record information may be requested or made on you including consumer credit, criminal records, driving record, education, prior employer verification, workers compensation claims and others. These reports will include experience information along with reasons for termination of past employment. Further, understand that information from various Federal, State, local and other agencies which contain your past activities will be requested. A consumer report containing injury and illness records and medical information may be obtained only after a tentative offer of employment has been made. By signing below, you hereby authorize without reservation, any party or agency contacted by this employer to furnish the above mentioned information. You further authorize ongoing procurement of the above mentioned reports at any time during your employment (or contract). You also agree that a fax or photocopy of this authorization with your signature be accepted with the same authority as the original. You have the right to make a request of First Advantage, upon proper identification and the payment of any legally permissible fees, for the information in its files on you at the time of your request. You hereby authorize and request, without any reservation, any present or former employer, school, police department, financial institution, division of motor vehicles, consumer reporting agencies, or other persons or agencies having knowledge about you to furnish First Advantage with any and all background information in their possession regarding you, in order that your employment qualifications may be evaluated. For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box. If checked and you are a California applicant, a copy of the consumer report will be sent within three (3) days of the employer receiving a copy of the consumer report. For California applicants only, if public record information about your character, general reputation, personal characteristics, and mode of living is obtained without using a consumer reporting agency, you will be supplied a copy of the public record information within seven (7) days of the employer s receipt unless you check this box where you hereby waive your right to obtain a copy of the consumer report. Print Your Full Name: Social Security #: - - Driver s License State: #: Street Address: City / State / Zip Code: Previous Address (if you have lived at above address for less than 5 years): Street Address: City / State / Zip Code: The following is for identification purposes only to perform the background check: Date of Birth (Month/Day/Year): Other or Former Names: Professional License: State: Type: Number: Signature: Date: (Revised 11/16/09) Page 1 of 1

8 Pre-Offer EMPLOYEE VOLUNTARY SELF-IDENTIFICATION (Confidential For Statistical Use Only) Hercules Offshore, Inc. is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation or any other classification protected by federal, state or local law. Hercules Offshore, Inc. is subject to certain governmental recordkeeping and reporting requirements for the administration of federal and state laws and regulations and responses will be used only for the necessary information to include in our Affirmative Action Program. Submission of this information is voluntary and refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment. This form will be kept separate from all other personnel records. We appreciate your assistance in helping us comply with our reporting responsibilities. Please return completed forms to the Human Resources Department. NAME: (Please print first and last name.) DATE: Please mark the description below that best describes your Race/Ethnicity and Gender. This self-identification of your Race/Ethnicity and Gender is voluntary. If you choose not to provide this information, please indicate below. I do not wish to Self-Identify my Race/Ethnicity & Gender. RACE/ETHNICITY* American Indian or Alaskan Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Two or more races (not Hispanic or Latino) GENDER Female Male (* - Please see Definitions on next page, if needed.) (Revised 06/01/11)

9 Definitions: RACE/ETHNICITY Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, South of Central American, or other Spanish culture or origin regardless of race. White (not Hispanic or Latino) A person having origins in any of the original peoples of Europe, the Middle East or North Africa. Black or African American (not Hispanic or Latino) A person having origins in any black racial groups of Africa. Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (not Hispanic or Latino) A person having origins in any of the original peoples of the Far East, Southeast Asia, of the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaskan Native (not Hispanic or Latino) A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or more races (not Hispanic or Latino) All persons who identify with more than one of the above five races.