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Employment Location *

Domestic Onshore
Domestic Offshore
International Offshore

Applicant Information

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Cell Phone *

Email *

Date available *

Last 4 digits of Social Security number *

Position applied for *

Desired salary

Are you a citizen of the United States *

If no, are you authorized to work in the U.S.?

Have you ever worked for Performance Energy Services? *

If yes, when? *

Education

High school name

Address (City & State)

From - To

Did you graduate?

Type of degree / diploma

College name

Address (City & State)

From - To

Did you graduate?

Type of degree / diploma

Other name

Address (City & State)

From - To

Did you graduate?

Type of degree / diploma / certification

Do you possess a driver's license or ID card? *

Drivers license state *

Drivers license or ID # *

Do you possess a TWIC card? *

If yes, please list TWIC # *

TWIC # located on back of card

TWIC expiration date *

List all license / certifications you have related to position applying for

References

Please provide the names of two persons whom you have known for at least three years. These persons must not be related to you or be a former employer.

Name

First

Last

Relationship

Years known

Address (City & State)

Phone

Name

First

Last

Relationship

Years known

Address (City & State)

Phone

Name

First

Last

Relationship

Years known

Address (City & State)

Phone

Previous Employment

Begin with your most recent / current employer.

May we contact your current employer?

Company

Address (City & State)

Phone

Job title

Supervisor

Starting salary $

Ending salary $

Responsibilities

Starting date employed

Ending date employed

Reason for leaving

Company

Address (City & State)

Phone

Job title

Supervisor

Starting salary $

Ending salary $

Responsibilities

Starting date employed

Ending date employed

Reason for leaving

Company

Address (City & State)

Phone

Job title

Supervisor

Starting salary $

Ending salary $

Responsibilities

Starting date employed

Ending date employed

Reason for leaving

Military Service

Are you Active or a Veteran *

If yes, please list branch *

Service from *

Service to *

Disclaimer and Authorization

I authorize you at the time of my application for employment, or during the course of employment to obtain information from any source as to my education, experience, character, medical history and financial or credit records.

I hereby certify that this application and any attachments contain no willful or negligent misrepresentations of falsifications, and that information given by me is true and complete. I understand that should an investigation disclose any such misrepresentation or falsification, my application will be rejected, or if employed by Performance Energy Services, LLC, will cause my dismissal.

Employment with Performance Energy Services, LLC is terminable at will by either party without cause and without notice. As an employee at will, you may voluntary resign your employment at any time and Performance Energy Services, LLC may terminate your employment at any time without cause or prior notice. No one at Performance Energy Services, LLC is authorized to change the at-will nature of the employment relationship between you and Performance Energy Services, LLC except the President/CEO in a written agreement signed with him/her.

Name *

First

Last

Signature *

If using a device with touchscreen, use finger or stylus to sign name. If using a laptop or desktop computer, use touchpad or mouse to sign name.

Date *

Consent To Obtain Consumer Reports

Read carefully before signing

1) I HAVE READ THE ATTACHED “NOTICE” TO APPLICANTS/EMPLOYEES REGARDING CONSUMER “REPORTS” AND HEREBY AUTHORIZED THE COMPANY TO OBTAIN CONSUMER REPORTS AND/OR INVESTIGATE CONSUMER REPORTS AS DESCRIBED

2) I UNDERSTAND THAT I HAVE THE RIGHT TO MAKE A WRITTEN REQUEST WITHIN A REASONABLE AMOUNT OF TIME TO RECEIVE ADDITIONAL, DETAILED INFORMATION ABOUT THE NATURE AND SCOPE OF ANY INVESTIGATIVE REPORT OR OTHER CONSUMER REPORTS THAT ARE MADE, INCLUDING THE NAME, ADDRESS, AND TELEPHONE NUMBER OF THE CONSUMER REPORTING AGENCY.

3) I HEREBY AUTHORIZE ANY PRESENT OR FORMER EMPLOYERS, CONSUMER REPORTING AGENCIES, EDUCATIONAL INSTITUTIONS, CRIMINAL JUSTICE AGENCIES, DEPARTMENT OF MOTOR VEHICLES, PUBLIC AGENCY, FINANCIAL INSTITUTIONS, OR ANY OTHER PERSON OR AGENCY HAVING KNOWLEDGE OF ME, TO SUBMIT INFORMATION OR OPINIONS OF MYSELF, INCLUDING DATA RECEIVED FROM OTHER SOURCES, IN ORDER THAT MY EMPLOYMENT QUALIFICATIONS MAY BE EVAULATED. I HOLD SAID PERSON AND/OR OPINIONS MADE REGARDING MY CHARACTER, EXPERIENCE, OR QUALIFICATIONS.

BY MY SIGNATURE BELOW, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE ABOVE STATEMENTS.

Name *

First

Last

Signature *

If using a device with touchscreen, use finger or stylus to sign name. If using a laptop or desktop computer, use touchpad or mouse to sign name.

Date *

QUESTIONAIRE

How did you hear about Performance Energy Services, LLC?

Newspaper

Website

Other

Word of Mouth
Sign
Job Fair
Billboard

Current Employee Referral

Other (Specify)

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PES ONLINE APPLICATION

Applicant Information

Education

References

Previous Employment

Military Service

Disclaimer and Authorization

Consent To Obtain Consumer Reports

QUESTIONAIRE

How did you hear about Performance Energy Services, LLC?