Application for Employment - Esso Exploration and Production Guyana Limited (EEPGL)

Please Complete in Block Letters and Print in Ink

Personal Information
Full Name (Last, First, Middle) Preferred / Call Name What is your year of birth?

Marital Status Gender Ethnic Background (optional)

____ Indian ____ African ___ Amerindian ___ Portuguese ___Chinese ___ Other, please specify _________________
Address Mobile Number

Email Address Alternate Phone Number

Upon request, can you provide written evidence that you are authorized to work in the country for which this job is posted in?

Country/Region where you have or most recently obtained, permanent residency or citizenship (whichever is most recent). Year permanent residency or citizenship in that country/region began.

If you hold citizenship in a country/region other than the country/region of your most What is your nationality? What is your country/region of birth?
recent permanent residence, please indicate.
Year you obtained this citizenship:

Are you currently a government official for Guyana? (The term "government official" includes 1) any agent, officer, or employee (elected or appointed, or career) in the Republic of Guyana
2) Any company in which the Republic of Guyana holds a substantial interest.

If yes, please provide the positon/title and government:

Do you have any relative(s) currently working for Esso Exploration and Production Guyana Limited? If yes, please provide the name(s) of the person(s):

Are you currently a member of the Board of Directors of any for-profit and/or non-profit organizations? ______ Yes ______ No: Please explain _____________________________

Please indicate employee equity held in company, remuneration for directorship, reasons why directorship should be considered, time commitment

Have you ever been employed (including internships) by PriceWaterhouseCoopers (our independent auditor) or any PwC affiliated company? ______ Yes ______ No: If yes, please provide type of
employment. Start date and end date _____________________________

Have you previously worked for ExxonMobil, Imperial or its affiliates as an employee? ______ Yes ______ No: Please indicate country/region _________________________

Have you previously worked for ExxonMobil, Imperial or its affiliates as a contractor ______ Yes ______ No: Please indicate country/region _________________________

Do you have a relative who works at this company, an affiliate, one of our vendors or another oil company? If yes, please provide the name, relationship, position or title and government
______ Yes ______ No: If yes, please indicate: _________________________

Have you been previously interviewed for a position with ExxonMobil, Imperial or its affiliates? How did you hear about opportunities at the company?

Employment Desired
What is the position you are applying for?

What is your monthly gross salary expectations? (include currency) When are you available to start working? How many years of relevant work experience do you have?

Education
(Below, please list all educational institutions you attended, starting with the most recent one)
Dates Attended Degree (Diploma, Certificate)
School(s) Locations
From (MO / YR) To (MO/YR) If no degree attained, please list the number of school years
1.

2.

If additional space needed, please use a separate sheet

List Job related courses and/or coursed completed in the field of study:
Course Title Date of Training Brief Description

Highest level of education completed or in progress: Major/Fields of study of highest education completed or in progress: University:

Country where you obtained the highest education: GPA (Also known as - Cumulative Grade Point Average, Course Is your final thesis/project approved?
Weighted Average or Score. Please enter N/A if GPA is not applicable to
your University/Institution. )
 Application for Employment - Esso Exploration and Production Guyana Limited (EEPGL)

Please Complete in Block Letters and Print in Ink

Full Name (Last, First, Middle)

Employment and/or Business Experience

Provide information about the last three jobs that you have held starting with the most recent. Please attach a detailed resume or CV if available.
1) Company City, Country Type of Business

Position Held Starting Date Date Left

Annual Gross Salary (or Hourly Wage) + Benefits + Other Payments in GYD Reason for Leaving

Major Job Duties

2) Company City, Country Type of Business

Position Held Starting Date Date Left

Annual Gross Salary (or Hourly Wage) + Benefits + Other Payments in GYD Reason for Leaving

Major Job Duties

3) Company City, Country Type of Business

Position Held Starting Date Date Left

Annual Gross Salary (or Hourly Wage) + Benefits + Other Payments in GYD Reason for Leaving

Major Job Duties

References
Name Relationship Telephone - Land Line

1.

2.

3.

Please provide the names of our employee you know best (if applicable)

Miscellaneous
Have you been convicted in a court of law?

______ No ______ Yes - If yes, please provide details on your conviction in a court of law

Have you been convicted of any alcohol and drug related offense?

______ No ______ Yes - Please provide details on your alcohol/drug related offense

I certify that the above information is true and complete to the best of my knowledge, without omission of any consequence. I agree that any misrepresentation, false statement, or omission,
made by me with respect to the information contained in the application or subsequent medical evaluation shall be sufficient cause to terminate any offer or my employment.

I also authorize you to require reports from previous and current employers, schools, references, and law enforcement agencies.

I further recognize that if I am offered employment, I will be required to undergo a post-offer medical evaluation and that my offer of employment will be conditioned upon the satisfactory
result of that medical evaluation. That medical evaluation will included testing for drug use, and I agree to such testing.

Signature: ___________________________________________________________________________ Date: ___________________

 Esso Exploration and Production Guyana Limited (EEPGL)
Supplemental Information Form

Please Complete in Block Letters and Print in Ink

Full Name (Last, First. Middle)

Position Application: Operations & Mechanical Technician

Skills and Languages

What specialized skills do you have? (Include any computer applications, technical training, licenses, etc.)

Please provide name of the courses /training, date and place, degree/certificate earned, and attach if possible.

How well can you read, write, interpret and speak English? (Please check one)

___Elementary ___Basic ___Experienced ___Fluent ___Primary

What additional languages do you know (how well do you speak, write, interpret and read) --- optional

Please Answer The Following

Yes No
1. I have attained at least a highschool education

2. I understand I may be required to attend training overseas or at other location as deemed necessary by the company

3. I understand that I may be required to perform physically demanding work

4. I understand that may be required to work and live offshore for extended periods of time

5. I understand that I will be required to follow the safety rules to perform all duties of the company

6. Job descriptions are very broad and you will be expected to perform all duties for which you are qualified

7. I understand that I may be required to work at heights with appropriate safety precautions

8. I understand that I may be required to wear personal protective equipment (PPE) : Hardhat, safety glasses, face
shields, safety shoes, etc.

9. I understand that I may be required to submit to random drug testing. A pre-employment medical review, a
background check and other review that may be necessary

10. You will be expected to work a rotational shift (for example:7 days on / 7 days off, 14/days on and 14 days off,
21/days on and 21 days off, 28/days on and 28 days offnights, etc.)

11 If scheduled or requested, I will report to work on religious holidays, weekends, etc.

I give the company the permission and the authority to verify the above information and I understand that misrepresentation or omission of facts
contained in this document will be sufficient cause for cancellation of consideration for employment or dismissal from the company's service if I
have been employed

Signature: ___________________________________________________________________________ Date: ___________________