APPLICATION FOR EMPLOYMENT

Information provided in this application and in any other documentation provided in support of an application for employment will be handled sensitively and in accordance with the principles as outlined in the Privacy Act 1988 (Commonwealth). For your application to be considered, each question is to be fully and accurately answered.

PERSONAL DETAILS First Name: Street Address: Post Code: Postal Address: Home Telephone: Email: If youre not an Australian citizen, do you have residency status?: Visa Type: POSTION DETAILS Position applied for:: Location: How did you hear about this position?: Employment desired: Availability to commence work: Have you previously applied to Apache?
If yes, what position:

Surname:

Post Code: Mobile:

Yes

No

Expiry Date:

Application Date:

Full-time

Part-time

Fixed Term

Temporary/Casual

Yes Location:

No Dates: Yes Dates: No Relationship: No

Have you ever been employed by Apache or worked for Apache as a contractor?
If yes, what position:

Location: Yes

Do you have any relatives working at Apache? EDUCATION AND TRADE SKILLS Institution Secondary Tertiary

Location

From

To

Qualification

Professional

Training Courses

Other Trade Skills

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EMPLOYMENT HISTORY
Begin with the most recent position and account for all unemployed time. Please attach CV for clarification. Do not write See CV or similar. Specific remuneration details must be provided for your application to be considered.

Position Held From (month/year): Company Name: Address: Main Duties: To (month/year):

Current Remuneration:
Please be specific on additional benefits, e.g. bonuses and equity.

Reason wanting to leave:

Position Held From (month/year): Company Name: Address: Main Duties: To (month/year):

Remuneration: Reason for Leaving: Position Held From (month/year): Company Name: Address: Main Duties: To (month/year):

Remuneration: Reason for Leaving:

Position Held From (month/year): Company Name: Address: Main Duties: To (month/year):

Reason for Leaving:

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OTHER SKILLS AND CREDENTIALS Summarise your special skills and/or strengths: Are you a member of any professional body or industry group? If yes, please list: Do you speak any foreign languages? If so, which ones and at what level?

OTHER DETAILS Have you ever been convicted of a crime, charged with any criminal offence or are you currently under criminal indictment? (Please exclude information concerning minor traffic violations, juvenile proceedings that have been judicially sealed, and any matter in which a court has ordered the records expunged). Yes No

If yes, please explain:

REFERENCES
List three professional referees (excluding friends or relatives).

Name

Organisation

Relationship

Phone

REMOTE SITE APPLICANTS ONLY TO COMPLETE Do you hold a current drivers licence?: If yes: R-N R-E R-N R C LR MR HR In confined spaces Helicopters Night shift

Are you prepared to work:

At heights

Over water Aeroplanes

Are you prepared to regularly travel in:

Small seacraft Yes No

If required, would you be willing to obtain police and maritime security clearances?

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TERMS OF APPLICATON FOR EMPLOYMENT I acknowledge that Apache Energy Ltd (the Company) is relying on the information I have provided. I certify that the information provided in this Application for Employment is true and correct to the best of my knowledge. I understand that false or misleading statements or material omissions may be cause for rejection of my application or my dismissal if I am employed. If employed, I agree to confirm to the rules, regulations and policies of the Company. Additionally, I understand that nothing contained in this Application for Employment or in the granting of an interview is intended to create a contract between the Company and me for either employment or the providing of any benefit. No guarantee is binding upon the Company unless made in writing and signed by an authorised representative of the Company. I understand that I will be required to take, at the expense of the Company, a pre-employment medical (including a drug and alcohol test) and authorise a background check, the results of which will be considered by the Company before any offer of employment is made (applicants are advised not to give notice of resignation to their present employer until they have been formally offered employment). I have read and understood the above.

Signature:

Date:

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