Thank you for your interest in Diversified Drilling Corporation.  How did you hear about us?

Date:

PERSONAL INFORMATION

Driver's License #:   State     Class: A B C  License Expiration Date:    

Name:    Last:    First:      Middle Initial:   Social Security #:

Address:   City:     State/Zip:

Telephone:                 Email:

Desired Location of Job: Tampa Orlando Ft. Myers    Position applying for: Part Time:  Full Time:

Referred Source: Rate of pay expected: Are you currently employed? Yes   No  

What date would you be able to start?:      

Have you ever worked for this Company before:    Yes   No     If yes, Dates From: To:

Reason for leaving:  

Names of any friends/relatives employed by this company:

Extensive, overnight travel may be required; can you travel if the job requires it? Yes   No   

Are you 18 or over? Yes   No         Are you legally permitted to work in the United States?  Yes   No

Have you ever been convicted of a felony? Yes No

If Yes, please explain:

Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

EMPLOYMENT EXPERIENCE

Please list the name of your previous employers in chronological order with present or last employer to account for all periods of time including military service and any period of unemployment.

Employer:                 Employed From: To: 

Address:                   City:         State/Zip: 

Position:            Reason for leaving:

Duties:                May we contact this Employer:    Yes     No     Phone:

Employer:                 Employed From: To: 

Address:                   City:         State/Zip: 

Position:            Reason for leaving:

Duties:                May we contact this Employer:    Yes     No     Phone:

Employer:                 Employed From: To: 

Address:                   City:         State/Zip: 

Position:            Reason for leaving:

Duties:                May we contact this Employer:    Yes     No     Phone:

DRIVING EXPERIENCE

Have you been cited for a traffic violation of any kind within the last Three (3) years? Yes   No

If Yes, please explain violation:

CDL Permit #:

Class of equipment driven:    Straight Truck         Tractor Trailer         Other

EDUCATION

Highest level completed: 1 2 3 4 5 6 7 8 9 10 11 12        College: 1 2 3 4

High School:             Years Completed: 1 2 3 4 0     Diploma? Yes   No

College:                     Years Completed: 1 2 3 4 0     Degree? Yes   No

Trade/Technical School:             Years Completed: 1 2 3 4 0     Degree? Yes   No

Specialized Job Related Skills & Qualifications:

Have you received any special certifications or awards? Yes No If Yes, please describe:

References:

Name:            Occupation:     Years known:

Address:         Phone:

Name:            Occupation:     Years known:

Address:         Phone:

Name:            Occupation:     Years known:

Address:         Phone:

APPLICANT'S STATEMENT

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job related medical condition or handicap, or any other legally protected status.

This application for employment shall be considered active for a period of time not to exceed 45 days.  Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I declare the information contained in this application is accurate and complete. I further understand that if I am employed, false information stated in this application shall be sufficient cause for dismissal.  I understand the employer may conduct a thorough investigation of my past work and personal history including motor vehicle reports and criminal background investigations.  I authorize the release of such information and release from liability any persons who provide such information to the employer

By checking here you accept the terms of this Application.  

Please complete and sign the Authorization Form (link below) and fax or mail to:
Diversified Drilling Corporation
8801 Maislin Drive
Tampa, FL  33637
ATTN: Sharon Nadeau
813-988-1132 (fax)

Background Search Release Authorization