POSITION(S) - Patterson UTI

APPLICATION FORM for employment with Patterson-UTI Drilling. (print clearly and complete in full)
POSITION(S) APPLYING FOR
N/A
Personal Information
Legal Name:_____________________________________________________________________________________
Last
First
Initial
Mailing Address:__________________________________________________________________________________
City/Town
Province
Home Phone:________________________________________
Alternate#________________________________
Do you have reliable transportation to and from work? (optional)
Valid Driver’s License: (optional)
Coverall Size:
Are you legally able to work in Canada?
Yes
Yes
Select
Yes
No
No
No
How did you hear about us? ________________________________________
Emergency Contact
Name: ___________________________ Relationship: __________________________ Phone: _______________________________
Work Experience
Rig Manager
_________ Yrs________Mo’s
Driller
_________ Yrs________Mo’s
Derrickman
_________ Yrs________Mo’s
Motorman
_________ Yrs________Mo’s
Floorhand
_________ Yrs________Mo’s
Leasehand
_________ Yrs________Mo’s
Type of Rig:
Size of Rig:
Previous Employers
Were you previously employed by Patterson-UTI Drilling (formerly Phelps Drilling)?
Name:
Yes
No
_________________________________________
______________________________________________
Position: _________________________________________
______________________________________________
Phone Number: ____________________________________
Length of
Service: _________________________________________
______________________________________________
______________________________________________
Valid Certificates
Are you enrolled in a Rig Technician Apprenticeship Program?
If yes, what level have you completed? Level 3
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Floorhand Training
Date Completed:
First Aid
Expiry:
Loader Certificate
Expiry:
Boilers
Expiry:
st
1 Line
Expiry:
Certificate #:
2nd Line
Expiry:
Yes
No
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Confined Space
Expiry:
Fall Protection
Expiry:
Rig Rescue
Expiry:
TDG
Expiry:
H2S
Expiry:
Certificate #:
WHMIS
Expiry:
I certify that all information contained in this application is true, complete and accurate. I understand that providing false
information may result in no offer of employment or immediate dismissal.
I understand I will be on probation for the first three calendar months of my employment. At any time during this period,
if Patterson-UTI Drilling deems it appropriate to terminate my employment for any reason, there is no obligation to pay
severance pay.
I authorize Patterson-UTI Drilling to use this information, at their sole discretion, within the limits of the law. I also
authorize Patterson-UTI Drilling to contact either my present or previous employers for references.
I understand that any offer of employment made by Patterson-UTI Drilling is conditional upon a satisfactory, job-related
medical assessment and drug screen. I also understand the occupational requirements and certify that I am able to
perform any physical requirements of the positions’ duties.
Submitting this form confirms your consent to the collection, retention, use and disclosure of your personal
information and work history as required for job selection, placement, training, payroll, and work bids for which you may
be considered. Your information will be kept on file for the Company’s reference should you be considered for other
employment with Patterson-UTI Drilling.
The job/position you are applying for is seasonal and/or based on specific projects. Section 55 of the Alberta Employment
Standards Code authorizes an employer to terminate employment without notice at the completion of the drilling season
or the completion of the well for which you are being hired.
Signature