OFFICE LOCATION

PATTERSON DRIVE WINNIPEG

MB ROC 2Z0 - CANADA
 +1 (204) 410-2422
 career@rocksonwestoilgas.com

APPLICATION FORM FOR EMPLOYMENT

AN EQUAL OPPORTUNITY EMPLOYER

PLEASE TYPE / PRINT / EMAIL TO ROCKSONWEST OIL & GAS

GENERAL - PERSONAL INFORMATION

Last Name First Middle Passport number

Home Address (Street & Number) City State Nationality

Previous Residences in the Canada Cell Phone / WhatsApp Email Address

Date of Birth: Day Month Years Place of Birth: Marital Status:

Ready to join immediately

before?
Yes No

If you're selected for the job within how many days you can join the company?

Designation/Position Applying For:

(First Choice) (Second Choice) Minimum Earnings Required

Do you want to travel with your family?

Yes NO
If yes, how many are they?

Are you able to perform the essential functions of the position for which you are applying, either with or without reasonable accommodations?

Yes No

EDUCATION
Number of Years GRAD. Major Field of Study
NAME AND LOCATION OF SCHOOLS Yes No Degree

High School Last Attended

Name

City State
College

or
Name

University
City State

City State
LICENSING

Identify each license or certification held, include serial numbers and expiration dates.

PAST EMPLOYMENT
If employed or previously employed, please complete the following section starting with your most recent or current employer.

May we contact your present employer: Yes No

Previous Company Name Telephone Number mo yr

From:
To:

Street City State Zip Code Type of Business

Previous Job Position: Last Salary:

Reason for leaving

SECURITY/RIGHT TO WORK
Are you legally authorized to work in the CANADA.? (Proof of identity and legal authority to work in the Canada. is a condition of employment.)

Yes No

IMPORTANT
Please make sure before submitting this form that it is complete and the required documents
are enclosed. incomplete forms will not be processed.

I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any
of the statements checked by the Rocksonwet unless I have indicated to the contrary. I authorize the references listed above, as well as all
other individuals whom the Rocksonwest Oil & Gas contacts, to provide the Rocksonwest Oil & Gas any and all information concerning my
previous employment and any other pertinent information that they may have. Further, I release all parties and persons from any and all
liability for any damages that may result from furnishing such information to the Rocksonwest Oil & Gas as well as from any use or disclosure
of such information by the Rocksonwest Oil & Gas or any of its agents, employees, or representatives. I understand that any
misrepresentation, falsification, or mission of information on this application may result in my failure to receive an offer or, if I am hired, my
dismissal from employment.

Human Resources Department

__________________________________
DATE / SIGNATURE
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