APPLICATION FOR RIG EMPLOYMENT

Please email to: l.evans-harvey@brinkerhoff.ca

#500 500 5th Avenue S.W. Calgary AB. T2P 3L5 Ph. 261-8668
NAME: ___________________________________________________________DATE: _____________
PHONE: (____)_______________________POSITION APPLIED FOR:__________________________
ADDRESS:_____ _______________________________
APT# STREET ADDRESS OR P.O. BOX NO.

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CITY

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PROVINCE POSTAL CODE

BIRTH DATE: _____________ HEIGHT:________ WEIGHT:________ S.I.N#___________________

VALID DRIVERS LICENSE: YES___ NO___ LICENSE#____________FOR THE PROVINCE OF_____
IN CASE OF EMERGENCY NOTIFY:_____________________________ CARE NUMBER:_____________
QUALIFICATIONS(CERTIFICATES):
1ST LINE
2ND LINE B.O.P
H2S ALIVE
OILWELL BOILER
ST. JOHNS AMBULANCE FIRST AID
WHIMIS
ENVIROMENTAL ISSUES

DATE TAKEN
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CERTIFICATE NO.
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HAVE YOU EVER HAD A BACK INJURY? ___ NUMBER OF TIMES___ DATE OF LAST HEARING TEST?
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LIST ANY PHYSICAL LIMITATIONS WHICH MAY EFFECT YOUR ABILITY FOR JOB APPLIED FOR:
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HAVE YOU EVER FILED A CLAIM WITH WORKERS COMPENSATION BEFORE? YES_____ NO ______
IF YES, PLEASE COMPLETE:
NATURE OF INJURY
DATE
LENGTH OF CLAIM

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____________________________________

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WHEN DID YOU LAST WORK ON A DRILLING RIG? _______________________ DEPTH RATING: ________
HAVE YOU WORKED FOR US BEFORE? __________ WHEN: ___________________ RIG NO:
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WORK HISTORY:
COMPANY NAME: __________________________________ ADDRESS: _____________________________
DATES: FROM: ____________ TO: _______________ POSITION HELD:
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COMPANY NAME: __________________________________ ADDRESS: _____________________________
DATES: FROM: ____________ TO: _______________ POSITION HELD:
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COMPANY NAME: __________________________________ ADDRESS: _____________________________
DATES: FROM: ____________ TO: _______________ POSITION HELD:
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The position you are applying for is seasonal or is based on specific projects. Section 58 of the Alberta
Employment Standards Code authorizes an employer to terminate your employment without further
notice or payments in lieu of notice, at
(a) The completion of the drilling season;
(b) The completion of the well for which you are being hired; or
(c) Continued employment is or has become impossible for the employer to perform because of
unforeseeable or unpreventable causes beyond his control, e.g. poor drilling results, decline in
the price of crude oil, etc.
SUBSTANCE ABUSE
Brinkerhoff Drilling has a formal Drug & Alcohol Policy in place. I understand that I am subject for
cause testing for substance abuse and will be required to undergo Random Rig Drug/Alcohol Testing. I
understand that employment is conditional upon a negative test.
SUBSISTENCE ALLOWANCE
If I resign my position I understand that I will receive subsistence allowance only if the following
conditions are met:
A) Seven (7) days advance written notice of intention to terminate is given to the Rig Manager;
B) I have completed the well.

I declare all the above statements to be true and accurate and understand that a false, misleading or
incomplete answer may be grounds for dismissal.
I further understand that failure to comply with Safety Regulations of this Company and applicable
legislation will provide grounds for dismissal.
DATE: _________________ EMPLOYEES SIGNATURE: _______________________________________
OFFICE USE ONLY: DATE HIRED: _______________ RIG NO.__________ POSITION: ________________
DATE REINSTATED: _________ REMARKS: __________________________________
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