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Employment Questionnaire
P.O. Box 600
Crescent, OK 73028
(405) 969-2141
fax: (405) 969-3675
P.O. Box 3783
Broken Arrow, OK 74013
(918) 747-3675
Name:*
Address:*
City:*
State:*
Zip Code:*
Cell Phone:*
Home Phone:
Date of Birth:*
Email:*
Do you have a valid
CDL
Oklahoma License?*
Yes
No
Do you have a valid
Oklahoma
Driver's License?*
Yes
No
Do you have any oilfield experience?*
Yes
No
Please list your last two places of Employment:
Dates of Employment:*
Start:*
End:*
Name of Employer:*
Name of Supervisor:*
Position:*
Reason for Leaving:*
Dates of Employment:
Start:
End:
Name of Employer:
Name of Supervisor:
Position:
Reason for Leaving:
Referred By:*
Do you have upcoming appointments needing days off?
When:
No. Days:
By initialing the following, you authorize GENIE WELL SERVICE, INC. to check your driving record and you acknowledge that this may be done from time to time after you are employed. Initial here:*
By signing below, you authorize GENIE WELL SERVICE, INC. to check your former employment record and you do further agree to
submit to a drug screen as a condition of employment with GENIE WELL SERVICE, INC.
12-21-2024
Signature*
Date
Employment Questionnaire Jan. 2019
© Genie Well Service 2024
