Name

First Name

Last Name

Phone

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you ever been employed by this company?

Have you ever applied for this company before?

Position Appyling For

If applying for a position where driving is required, do you have a valid Commercial Drivers License?

Can you perform the essential functions of the job(s) for which you are applying?

Are you available to work:

Full time

Part time

Overtime

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?

Professional References

List three (3) non-relative references who are familiar with your qualifications, work history, and ability. Please include: Name, Occupation/Relationship, Years Known, Telephone

Previous Employer 1

Employer Name

Supervisor's Name

Position

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone

(###)

###

####

Duties

Reason For Leaving

Employed from (mo/yr) to (mo/yr)

May we contact this employer?

Previous Employer 2

Employer Name

Supervisor's Name

Position

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone

(###)

###

####

Duties

Reason For Leaving

Employed from (mo/yr) to (mo/yr)

May we contact this employer?

Previous Employer 3

Employer Name

Supervisor's Name

Position

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone

(###)

###

####

Duties

Reason For Leaving

Employed from (mo/yr) to (mo/yr)

May we contact this employer?

Electronic Signature

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS THAT ARE SIGNED AND DATED ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK BEFORE SIGNING. I certify that all answers and statements I have made on this application (and resumé or other supplementary materials) are true and complete without omissions. By signing below, I authorize Hovden Oil to investigate all statements contained in this employment application as they may deem necessary in arriving at an employment decision. I understand that any false information provided by me will likely result in a refusal to hire or immediate discharge if I am employed. I authorize any of the persons or organizations named in this application to give you complete information and records regarding my employment, education, character, and qualifications. If hired, I will be responsible for familiarizing myself with all rules and regulations of Hovden Oil as they presently exist or are later modified. If hired, I understand my employment can be terminated at the discretion of Hovden Oil or at my option, without notice, at any time, and for any reason. I also understand that no representative of Hovden Oil has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment, except as specifically stated in a current written agreement signed by the president of Hovden Oil. I understand this application is not an offer of employment and no promises or representations of employment have been made to me at this time. I have read, understand, and agree with the above. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

HEADQUARTERS

PO Box 28

1425 Main St. Ridgeway, Iowa 52165

Phone: (563)737-2710

Phone: (800)280-6600

Fax: (563)737-2389

Email: office@hovdenoil.com

OTHER LOCATIONS

Cedar Rapids Office: (319)365-1108

Decorah Office: (563)382-5314

New Albin Office: (563)737-2710