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Employment Application

Employment Application
First
Middle
Last
Current Address
Street Address
apartment or building number
City
State/Province
Zip/Postal
Country
Have you lived at the above residence for at least 3 years? *

Previous Residence Addresses

Previous Address 1 *
Previous Address 1
City
State/Province
Zip/Postal
Country
Previous Address 2
Previous Address 2
City
State/Province
Zip/Postal
Country

Employment

Do you desire *
Are you currently employed? *

Relatives In Our Employment

list any relatives you have that currently work for Keenan Energy

Education

Criminal Background

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)]

Licenses

(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? *

Driving Experience

(Van, Tank, Flat, etc.)

Accident Review for the past 3 years

(head-on, rear-end, overturn, etc.)

Traffic Convictions and Forfeitures for the past 3 years other than parking viololations

Employment Record

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

Full Company Address
Full Company Address
City
State/Province
Zip/Postal
Country

Maintenance Experience & Qualifications

Job Function

Indicate training and exprience in the following areas

Drive Line Components
Diesel Engine Tune-up and Rebuild
Gas Engine Tune-up and Rebuild
Tire Service
Trailer Repair
Air Conditioning
Body Work
Electrical Repair
Frame & Wheel Alignment
Brakes
Cooling System
Inspections
General Car Repair

Shop Equipment

Indicate training and exprience in the following areas

Electrical Diagnostic Equipment
Sheet Metal Equipment
Frame & Axle Straightening Equipment
Engine Rebuilding
Diesel Injection Equipment
Electric Welder
Oxyacetylene Welder
Paint Spray Gun
Air Conditioning
Tire Servicing Machine
Wheel & Tire Balancing Machine
Tire Recapping Mold
Engine Dynamometer
Chassis Dynamometer
Magnetic Crack Detector
Engine Analyzer
Noise Measuring Equipment
Smoke Measuring Equipment
Inspections
General Car Repair

Clerical Exprience & Qualifications

Indicate training and exprience in the following areas

Typing (wpm)
Shorthand (wpm)
Billing
Filing
Computers
Word Processing Equipment
Key Punch
Calculator
Adding Machine
Telecopier
Photocopier
Dictating Machine
Bookkeeping Machine
Switchboard Equipment
Tabulator
Accounting
OS & D
Interline
Claims
Cashier
Dispatcher

Platform Exprience & Qualifications

Indicate training and exprience in the following areas

Maximum upload size: 5MB

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.

Sending