Have you lived at the above residence for at least 3 years?
Previous Residence Addresses
Previous Address 1
Previous Address 2
Relatives In Our Employment
list any relatives you have that currently work for Keenan Energy
Have you ever been bonded?
Have you ever been convicted of a felony?
(conviction of a crime is not an automatic bar to employment - all circumstances will be considered)
Have you ever worked for this company under another name?
Are you applying for a driving position?
Driver Experience & Qualification
(answer this section only if you are applying for a driving position)
(the US Dept. of Transportation requires that the driver applications state their DOB & SSN [49 CFR Part 391.21 (b)(2))
Were you subject to the Federal Motor Carrier Safety Regulations while employed by that previous employer(s)?
Was past employment job designated as a safety sensitive function in any DOT regulated mode subject to alchohol and controlled substances testing requirements as required by 49 CFR - Part 40?
Information requried by [49 CFR Part 391.21 (b)(10)(IV)(A&B)]
(Drivers Licenses held in the past 3 years must be shown)
A. Have you ever been denied a license, permit or privilage to operate a motor vehicle?
B. Has any license, permit or privilege ever been suspended or revoked?
C. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?
Accident Review for the past 3 years
Traffic Convictions and Forfeitures for the past 3 years other than parking viololations
The U.S. Department of Transportation requires that driver applications show all employment for the past three years. They must also show commercial driver employment for the seven years immediately preceding this year period. §391.21 (B) (10), (11)
Start with last or current·position, including military experience, and work back.
Current & Previous Employment
Application Must Read & Sign
I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not, and I release employers and other persons named herein from all liability for any damages on account of furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test.
I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason.
It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include and investigative Consumer Report. including information regarding my character, general reputation, personal characteristics, and mode of living.
I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.
I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.
If hired, I agree to abide by all the rules and policies of the employer.
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.