O’KEEFE DRILLING EMPLOLYMENT APPLICATION
P.O. BOX 3810 BUTTE, MT 59701 406-494-3310
APPLICANT INFORMATION
Last Name First M.I. Date
Street Address Apartment/Unit #
City State ZIP
Phone E-mail Address
Date Available Social Security
No. Desired Salary
Position Applied for
Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO Have you ever worked for this company? YES NO If so, when?
Have you ever been convicted of a felony? YES NO If yes, explain
SPECIAL SKILLS AND TRAINING
Drilling:
Heavy Equipment: Welding:
Other:
EDUCATION
High School Address
From To Did you
graduate? YES NO Degree
College Address
From To Did you
graduate? YES NO Degree
Other Address
From To Did you
graduate? YES NO Degree
REFERENCES
Please list three professional references.
Full Name Relationship
Company Phone ( )
Address
Full Name Relationship
Company Phone ( )
Address
Full Name Relationship
Company Phone ( )
PREVIOUS EMPLOYMENT
Company Phone ( )
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone ( )
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone ( )
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
MILITARY SERVICE
Branch From To
Rank at Discharge Type of Discharge
If other than honorable, explain
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
O’KEEFE DRILLING EMPLOLYMENT APPLICATION Driver Experience & Qualification
Licenses State License Number Type Expiration Date
Drivers Licenses Held in Past 3 yrs. Please provide Years.
Question YES NO
Have you ever been denied a license permit or privilege to operate a motor Vehicle?
Has any license permit or privilege ever been suspended or revoked?
Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?
** If you answered “YES” to any of the above questions attach a statement giving details.
Driving Experience
Class of Equipment Type of Equipment (Van, Tank, Flat, Etc.)
Dates
To From Apx. Miles
Straight Truck
Tractor & Semi-Trailer Twin Trailers
Other
List States operated in during last five years. _____________________________________________ __________________________________________________________________________________ List special courses or training that will help you as a driver. _________________________________ __________________________________________________________________________________ List Safe Driving awards held and who awards were presented by? ____________________________ __________________________________________________________________________________
Accident Review past 3 years. (Attach separate sheet if more space is needed)
Dates Nature of Accident Fatalities Injuries
Last Accident Next Previous Next Previous
Traffic convictions and forfeitures for the past 3 years. (No parking violations)
O’KEEFE DRILLING EMPLOLYMENT APPLICATION
Per the job description attached, the job may require lifting up to 50 pounds. Do you have any physical limitations or prior injuries to the back, knee, thighs or shoulders that would limit your ability to perform the job description?
NO_____ YES_____ If YES, please Explain:
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ______
This job may require a great deal of hand dexterity, do you have any prior injuries or limitations with regard to the arms, hands, wrist, or fingers which could interfere with completion of the job
duties?
NO_____YES_____ If YES, please Explain:
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ______
To your knowledge, do you have any other limitations or prior injuries which could interfere with completion of job duties?
NO_____YES_____ If YES, please Explain:
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ______
Acknowledgment
I have read and acknowledge the receipt of the attached O’Keefe Drilling Company job
description and Controlled Substance Policy from the Safety Manual. I agree to submit to a urinalysis screening test at the time of the pre-employment and D.O.T physical exam. I understand that if I refuse this test I will not be considered for employment.
I understand full-time employees newly hired are subjected to a 6 month evaluation or introductory period to verify skills, capabilities and suitability for our company. The 6 month evaluation period does not include lay off time and begins when actually beginning to work for
O’Keefe Drilling. At the end of the 6 months, the supervisor may extend the period for additional time at his or her discretion.
O’KEEFE DRILLING EMPLOLYMENT APPLICATION Title: Sampler/ Third Hand
Purpose:
To collect the drill hole samples and record them per the mining company’s instructions. assist the driller and driller helper.
Responsibilities:
-Know the mining company requirements for sampling. -Have adequate supplies on hand to contain the sample. -Record, tag and log the sample correctly.
-Adequately split samples to specifications for each sample bag. Each bag is 30inches by 16 inches and can weigh up to 25 pounds.
-Maintain and clean sampling devise on a regular basis.
-Assist the driller and driller helper in whatever way they deem necessary to effectively complete the job at hand.
-Addition jobs that may be required but not limited to: maintenance of the drill rig or auxiliary trucks, movement of equipment to the next location, packing up and cleaning of the job site, loading of materials or tools used, assisting the process of lay8ing down drill rods, and making connections coming out of the hole.
Education and Training:
-Minimum of High School diploma or equivalent.
-MSHA training and updating.
-General understanding of mechanics and engine maintenance. -OSHA 40hr Hazwoper helpful but not necessary
Requirements:
-Must be able to understand written mining company requirements for sampling and keep adequate records.
-Additional lifting, ability to lift 50 pounds.
-Physical good health is the employees’ responsibility; however, the company will provide and require a regular physical that may include drug screening, blood tests, back x-rays and other test required by the client on a specific job site.
Recommended:
-Commercial Driver’s License with appropriate endorsements for the vehicles included in