American Petroleum Services, Inc.

APPLICANT DATA

How were you referred to us:

Position applying for:

Full Name:

Address:

City:

State:

Zip:

Phone:

Mobile/Pager/Other:

E-mail:

Date Available to Start:

If you are under 18 years of age, can you provide a work permit?
Yes No

Have you ever worked for this company?
Yes No

Are you legally allowed to work in the United States?
Yes No

Answering yes to these questions does not constitute an automatic rejection for employment.

Type of employment desired (check all that apply):
Full-Time Part-Time Temporary Seasonal

EDUCATION HISTORY

Name & Location of High School:

Did you graduate?

Name & Location of College:

Year attended:

Degrees completed:

Other Subjects Studied:

Trade, Business or Correspondence School:

Year attended:

Subjects Studied:

Did you graduate?

SUMMARIZE YOUR SPECIAL SKILLS OR QUALIFICATIONS

PREVIOUS EMPLOYMENT (BEGIN WITH MOST RECENT POSITION) 1

Dates of Employment - From:

To:

Position(s) Held:

Company Name:

Address:

City:

State:

Zip:

Phone:

Supervisor:

Title:

Responsibilities:

Starting Title:

Ending Title:

Reason for leaving:

May we contact this employer for a reference?
Yes No

PREVIOUS EMPLOYMENT (BEGIN WITH MOST RECENT POSITION) 2

Dates of Employment - From:

To:

Position(s) Held:

Company Name:

Address:

City:

State:

Zip:

Phone:

Supervisor:

Title:

Responsibilities:

Starting Title:

Ending Title:

Reason for leaving:

May we contact this employer for a reference?
Yes No

PREVIOUS EMPLOYMENT (BEGIN WITH MOST RECENT POSITION) 3

Dates of Employment - From:

To:

Position(s) Held:

Company Name:

Address:

City:

State:

Zip:

Phone:

Supervisor:

Title:

Responsibilities:

Starting Title:

Ending Title:

Reason for leaving:

May we contact this employer for a reference?
Yes No

If you have a resume available, please attach it here.

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (AIDA) and other relevant federal and state laws.”

Signature of Applicant (type your full name):

Date:

Employment Application