Employment Application – Rongo Energy LLC

Applicant Information

Applicant Full Name

First

Last

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Daytime Phone

Evening Phone

Mobile Phone

Email

Social Security Number

Driver's License (State/Number)

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Emergency Contact

Contact Name

First

Last

Relationship to you

Address

Address Line 1

Address Line 2

City

State

Zip Code

Daytime Phone

Evening Phone

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Employment

Job Position Applied For

Full or Part Time?

Full Time
Part Time

Who referred you to our company?

Do you have any friends or relatives who work here? If yes, please list here

Have you applied to our company previously?

How will you get to work?

Are you willing to work any shift, including nights and weekends?

If applicable, are you available to work overtime?

If you are offered employment, when would you be available to begin work?

If hired, are you able to submit proof that you are legally eligible for employment in the United States?

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Employment Continued

THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.

Have you ever been convicted of a felony or misdemeanor?

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Applicant Skills

Check those skills that you have. List any other skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number that corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

Skill

Manual Transmission

Manual Transmission

Years of Experience

Ability or Rating

Doubles / Triples Endorsement

Doubles / Triples Endorsement

Tanker Endorsement

Tanker Endorsement

Hazmat Endorsement

Hazmat Endorsement

Tire Chains

Tire Chains

Oil Field Experience

Oil Field Experience

Crude Oil Experience

Crude Oil Experience

Mountain Driving Experience

Mountain Driving Experience

Additional Skills

Other Skill #1

Other Skill #2

Additional Skills

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Applicant Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) that you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.

Employer Name #1

Supervisor Name

Empoyer Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Duties

Reasons for Leaving

Dates of Employment (Month/Year)

Employer #2

Employer Name #2

Supervisor Name

Empoyer Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Duties

Reasons for Leaving

Dates of Employment (Month/Year)

Employer #3

Employer Name #3

Supervisor Name

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Duties

Reason for Leaving

Dates of Employment (Month/Year)

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Applicant's Education and Training

College/University Name

College/University Address

Address Line 1

Address Line 2

City

State

Zip Code

Did you receive a degree?

High School/GED Name

High School/GED Address

Address Line 1

Address Line 2

City

State

Zip Code

Did you receive a degree?

Additional Training

Other Training (graduate, technical, vocational):

Please indicate any current professional licenses or certifications that you hold:

Awards, Honors, Special Achievements:

Military Service

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References

List any two non-relatives who would be willing to provide a reference for you

Reference #1 Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Relationship

Reference #2

Reference #2 Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Relationship

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:

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Upload Picture of Your Drivers License (Front)

Click or drag a file to this area to upload.

Upload Picture of Your Drivers License (Back)

Click or drag a file to this area to upload.

Upload Picture of Your Medical Card (Front)

Click or drag a file to this area to upload.

Certification

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for the rejection of my application or, if employment commences, immediate termination. I authorize Rongo Energy LLC to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its VP of Operations, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Rongo Energy LLC, except in a specific written contract of employment signed on behalf of the organization by its VP of Operations, has the power to alter or vary the voluntary nature of the employment relationship. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION, AND I UNDERSTAND AND AGREE TO ITS TERMS.

Signature

Clear Signature