Employment

Position Applied For (required)

Date

Name (Last, First, MI) (required)

Address

Home Telephone

Cell Telephone

Your Email (required)

Driver's License Number / State Issued

Passport Number / Expiration Date

Place (City & Country)

Are you a Citizen?
YesNo

If no, please provide proof of work authorization (Resident Card, i-9, EAD, etc)

Are you over the age of 18?
YesNo

Do you have a valid TWIC (Transportation Worker Identification Card)?
YesNo

Do you have proof of current safety training (Safe Gulf, Water Survival, Confined Space, etc.)?
YesNo

If answer above is YES, please list all valid safety certificates / cards.

Please list any formal training / certificates / experience that would qualify you to work for Premier.

Where are you willing to work? (you may select more than one answer)
Offshore (Platforms/Drilling Rigs/Vessels)Dockside Shore Base24 hour, 7 days a week on call14 days on, 7 days offOverseas (Passport required)

ANY PRIOR CONVICTIONS

Have you ever been convicted of any crime which resulted in imprisonment, probation, or the payment of a fine or forfeiture or bail of $50 or more (a yes answer does not automatically disqualify you)?
YesNo

If answer above is YES, please explain when, where, and the disposition of the case. (Note: convictions that have been sealed, expunged or statutorily eradicated need not be listed)

Please re-type the image you see below.