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Application for Employment

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Phone

This field is for validation purposes and should be left unchanged.

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, or other protected classification. We are an equal opportunity employer.

Name*

Telephone Number*

Email*

Address (if at present address for less than (3) years)

Street Address City State ZIP Code

Previous Address:

Street Address City State ZIP Code

(if at present address for less than (3) years)

How long at this address?

Are you over 18 years old?

Yes

Date of Birth (required for CDL applicants only)

MM slash DD slash YYYY

Are you legally eligible to work in the U.S. on an unrestricted basis?

Yes

Date available:

MM slash DD slash YYYY

Have you worked for Rorrer Well Drilling Inc. before?

Yes

If yes, Month / Year

Position(s) applied for

Wage or salary desired?

When can you start?

Are you willing to work overtime if required?

Yes

Are you willing to take pre-employment and random drug/alcohol screening tests as a condition of employment?

Yes

The position may require working overnight or out of town. Do you have any objections to this?

Yes

Have you ever been convicted of a felony?

Yes

(Conviction will not necessarily disqualify an applicant for employment.)

If yes, describe conditions

Education

High School

Name & location of school

Course of Study

Years Completed

Diploma / Degree

College/Univ.

Name & location of school

Course of Study

Years Completed

Diploma / Degree

Other (specify)

Name & location of school

Course of Study

Years Completed

Diploma / Degree

In addition to your work history, what other experiences, skills, or qualifications would especially fit you for work with our company?

License Information

Section 383.21 FMCSR states: “No person who operates a commercial motor vehicle shall at any time have more than one driver’s license.” I certify that I do not have more than one motor vehicle license, the information for which is listed below.

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Yes

If Yes, Date

MM slash DD slash YYYY

Explain

If Yes, Date

MM slash DD slash YYYY

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Yes

If Yes, Date

MM slash DD slash YYYY

Explain

Other (specify)

Issuing State

License No.

Class / Type

Endorsements

Expiration Date

Driving Experience for Past 3 Years

Class of Equipment

Straight Truck

Type of Equipment (VAN, TANK, FLAT, ETC.)

Date (FROM)

Date (To)

Approx. No. of Miles (Total)

Tractor and Semi-Trailer

Type of Equipment (VAN, TANK, FLAT, ETC.)

Date (FROM)

Date (To)

Approx. No. of Miles (Total)

Tractor - Two Trailers

Type of Equipment (VAN, TANK, FLAT, ETC.)

Date (FROM)

Date (To)

Approx. No. of Miles (Total)

Other

Type of Equipment (VAN, TANK, FLAT, ETC.)

Date (FROM)

Date (To)

Approx. No. of Miles (Total)

Accident Record for Past 3 Years

Other (specify)

Dates

Nature of Accident (Head‑on, Rear‑end, Upset, etc.)

Number of Fatalities

Number of Injuries

Chemical Spills (Yes/No)

Traffic Convictions and Forfeitures for the Past 3 Years (Other than Parking Violations)

Date Convicted (Month/Year)

Violation

State of Violation / Location

Penalty (Forfeited Bond, Collateral, and/or Points)

Employment Record

Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. CDL applicants must provide information for all employers that they have driven a commercial motor vehicle for during the last ten years. Must list the complete mailing address: street number and name, city, state, and ZIP code. Start with your present employer.

Present Employer

Name

Address

Street Address City State ZIP Code

Phone

Position Held

From

MM slash DD slash YYYY

Reasons for Leaving

Salary

Any Gaps in Employment and/or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason.

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) by this employer?

Yes

Was this job position designated as a safety‑sensitive function in any DOT‑regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40?

Yes

Previous Employer

Name

Address

Street Address City State ZIP Code

Phone

Position Held

From

MM slash DD slash YYYY

Reasons for Leaving

Salary

Any Gaps in Employment and/or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason.

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer?

Yes

Was the previous job position designated as a safety‑sensitive function in any DOT‑regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40?

Yes

Previous Employer

Name

Address

Street Address City State ZIP Code

Phone

Position Held

From

MM slash DD slash YYYY

Reasons for Leaving

Salary

Any Gaps in Employment and/or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason.

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer?

Yes

Was the previous job position designated as a safety‑sensitive function in any DOT‑regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40?

Yes

Previous Employer

Name

Address

Street Address City State ZIP Code

Phone

Position Held

From

MM slash DD slash YYYY

Reasons for Leaving

Salary

Any Gaps in Employment and/or Unemployment Must Be Explained. Include Dates (Month/Year) and Reason.

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by the previous employer?

Yes

Was the previous job position designated as a safety‑sensitive function in any DOT‑regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40?

Yes

References

Give name, address, and telephone number of three references who are not related to you and are not previous employers.

Name

Address

Telephone Number

Give name, address, and telephone number of three references who are not related to you and are not previous employers.

To Be Read and Signed by Applicant

By submitting this form, I certify that I completed this application and that all information provided is true and complete to the best of my knowledge.

I authorize you to conduct investigations and inquiries into my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision.

I understand that any false or misleading information provided during the application or interview process will result in my immediate discharge if I am hired, regardless of when discovered.

I understand that this application is not a contract of employment. I also understand that any offer of employment may be conditioned upon a health evaluation by a doctor selected by the Company, to determine whether I can perform the job duties.

In addition, I understand that pre‑employment and random drug or alcohol testing will be required per Company policy.

I authorize the Company to make a thorough investigation of my past employment, personal references, education, and job‑related activities, and I release from all liability all persons, companies, and corporations supplying such information. I also indemnify this Company and its employees against liability which might result from making such investigation.

I understand that the information I provide regarding personal references, current and/or previous employers may be used, and those references and/or employers will be contacted.

I understand that I have the right to:

(A) Review information provided by my personal references, present and/or previous employers.

(B) Have errors in the information corrected by present and/or previous employers, and for those employers to re‑send the corrected information to the prospective employer.

(C) Have a rebuttal statement attached to the alleged erroneous information, if the present and/or previous employer(s) and I cannot agree on the accuracy of the information.

Join Our Team

Application​ ​for​ ​Employment

Join Our Team

Education

License Information

Employment​ ​Record

References

Application for Employment

Employment Record