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 Laborde APMC Drilling Parker Drilling Blake Drilling R&B Falcon Cliffs Drilling Reading and Bates Drilling 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 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 12/16/09) Page 1 of 5

2 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 that 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 12/16/09) Page 2 of 5

3 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 12/16/09) Page 3 of 5

4 Employment History continued. (Revised 12/16/09) Page 4 of 5

5 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 12/16/09) Page 5 of 5