GM Application

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Online Driver Application

Complete All Required Fields

Red = Required

Personal Info
First Name:
M.I.:
Last Name:
Street Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Email:
SSN:	* We Will Call for SSN
Date Of Birth mm/dd/yy:

License Info
CDL #:
CDL State:

Previous CDL Info
Previous CDL #:
CDL State:

Endorsements
Hazmat:
Doubles\Triples:
Tank:
Passenger:

Background Info
# of preventable accidents in the last 3 years?
# of moving violations in the last 3 years?
Have you ever had any DUI's/DWI's?
Have you ever had any felonies?

Preferences

When would you be available to start:

Experience

Amount Of Crude Oil Experience:

Employment History (10 Years History Required)
Last or Current Employer
Company:
City:	State:
Phone:
Title:	mm/dd/yy
Employed From: To:
Reason For Leaving:

Prior Employer 2
Company:
City:	State:
Phone:
Title:	mm/dd/yy
Employed From: To:
Reason For Leaving:

Prior Employer 3
Company:
City:	State:
Phone:
Title:	mm/dd/yy
Employed From: To:
Reason For Leaving:

Prior Employer 4
Company:
City:	State:
Phone:
Title:	mm/dd/yy
Employed From: To:
Reason For Leaving:

Prior Employer 5
Company:
City:	State:
Phone:
Title:	mm/dd/yy
Employed From: To:
Reason For Leaving:

Prior Employer 6
Company:
City:	State:
Phone:
Title:	mm/dd/yy
Employed From: To:
Reason For Leaving:

Prior Employer 7
Company:
City:	State:
Phone:
Title:	mm/dd/yy
Employed From: To:
Reason For Leaving:

Additional Comments

I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation in this application is sufficient cause for refusal to hire or dismissal if I have been hired regardless of date of discovery by the Company.

I give permission for Gulfmark Energy Inc. to order MVR, DAC Reports, and do Background Checks. (Required) I authorize the company to thoroughly investigate all statements contained in this application or resume, and I authorize my former employers to disclose information regarding my former employer, character and general reputation of the Company without giving me prior notice to such disclosure. In addition, I release the Company and any former employers from any claims, demands, or liabilities arising out of or related to such investigation and/or disclosure.

I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create any employment contract. I further understand and agree that if I am hired any employment will be "AT WILL" and without fixed term and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon the Company unless made in writing.

I understand that completion of this application does not indicate employment availability and does not obligate the Company to hire me. I agree to adhere to all Company work rules, policies and procedures. Gulfmark Energy Inc. reserves the right to revise its policies or procedures, in whole or in part at any time.

Gulfmark Energy Inc. does not discriminate in hiring or employment on the basis of race, color, creed, national origin, sex, age, sexual orientation, disability, or status as a disabled veteran or a veteran of the Vietnam Era, or any basis prohibited by state or federal law. No question on your application is intended to secure information used for such discrimination. All applicants and employees will be treated equally in conformity with all existing laws.

I HAVE READ AND UNDERSTOOD THIS AGREEMENT AND BY MY ELECTRONIC SIGNATURE BELOW INDICATE MY ACCEPTANCE WITH ITS TERMS.

Electronic Signature: X(Type your full name)

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