EASTERN WESTERN P.O. Box 669 P.O. Box 69 Name Carlin, Nevada 89822 Golconda, Nevada 89414 Telephone: 775-778-4000 Telephone: 775-635- Fax: 775-778- 9400Fax: 775-635-4660 NEWMON 4753 THIS APPLICATION WILL NOT BE CONSIDERED UNLESS ALL QUESTIONS ARE ANSWERED AND THE APPLICATION IS MAILED TO HUMAN RESOURCES AT AN ADDRESS ABOVE. IT IS NEWMONT MINING CORPORATION'S POLICY TO ACCEPT APPLICATIONS TFOR POSITIONS CURRENTLY BEING RECRUITED AND THOSE APPLICATIONS WILL REMAIN ON FILE FOR 6 MONTHS.
Applicant Name Last First Middle Social Security #
Present Address Number and Street City State Zip RO. Box Primary Telephone
Alternate Telephone
You may, but are not required to, provide an emergency contact. If you choose to provide a contact, complete the following:
Emergency Contact Name Relationship
Address Number and Street City State Zip Telephone
Position applied for? (be specific) Are you applying for full-time work? When could you report to work?
Have you ever applied for work with Newmont? If so, when? Have you ever worked for Newmont?
If so, dates: From TO
FOR COMPANY USE ONLY
Review Date Applicant Status Position applied for (Job Code) Date Referral Source Skills 1. 2.
Comments: Job Service
Interview Newspaper Advertisement
Date By Personal Friend
Date B Employment Agency y Date B Other y Interview Comments Applicant Status
P.E.P. Sec Ref
Name of Source
R.T.W. Applicant Status
Page I NGC-1062 Applicant Name Position applied for 1. WORK HISTORY List your employment history for a minimum of five (5) years, beginning with today's date and going backward, whether working or not. Show periods of employment, unemployment, military service, school, etc., exactly as they occurred List any additional experience related to job applied for on Page 3. Attach resume if available.
A. Your last employer, occupation or period of unemployment ______Location Last position held
Date(s) of service From TO Supervisor Phone No. Reason for leaving or unemployment Last rate of pay Additional positions held
B. Next to last employer, occupation or period of unemployment ______Location Last position held
Date(s) of service From TO Supervisor Phone No. Reason for leaving or unemployment Last rate of pay Additional positions held
C. Second-to-last employer, occupation or period of unemployment ______Location Last position held
Date(s) of service From TO Supervisor Phone No. Reason for leaving or unemployment Last rate of pay Additional positions held
D. Third-to-last Employer, Occupation or Period of Unemployment ______Location Last position held
Date(s) of service From TO Supervisor Phone No. Reason for leaving or unemployment Last rate of pay Additional positions held
2. EDUCATION Do you: Read English? Write English? Speak English? Are you fluent in any language other than English? (specify): Read? Write? Speak? Last Grade Name & Location of School Number of Degree (type) or Certification Completed Years Attended High School College or Univ. Voc Tech or Bus. School Major Fields of Study Circle Your Grade Average: High School Below 60 61-70 71-80 81-90 91-100 College Below 60 61-70 71-80 81-90 91-100 3. SKILLS Typing: WPM Word Processing: SPM Data Processing SPM Dictaphone
Office Business Machines Operated Computer Software & Equipment you are Qualified on
Plant or Mobile Equipment you are qualified to operate Maintenance Skills (Welder, Millwright, Mobile Equipment, etc.) 4. TRAINING List any additional training: (vocational courses, seminars, mine rescue, etc.)
Page 2
. Use these lines to list additional work experience
Use these lines for additional comments
References: provide name, address, and phone
5. GENERAL: Answer all questions by placing ''X'' in proper column. a. Are you at least 18 years of age? YES NO b. Do you have a valid driver's license? YES NO
C Have you ever applied for unemployment compensation? YES NO . If so, number of times YES NO d. Have you ever been discharged or asked to resign from employment for any reason? YES NO If so, give reason YES NO e. Have you ever been convicted of any crime, including convictions by a plea of nolo contendere or a deferred adjudication of guilt? (Other than routine traffic expenses?) YES NO If so, give offenses YES NO Date(s) of Conviction(s) YES NO
Length of confinement (if any) YES NO
f. Can you provide proof that you are eligible to work in the United States?
6. As a condition of employment you may be required to work overtime when needed. You may also be required to work shift work, holidays and weekends. If you are available to work all of the overtime and shift work, indicate by signing below. (Applicants need not indicate the need for any absences for religious practices. Applicants should state whether they are otherwise available to work these hours.)
Signed: Date: Page 3 CERTIFICATION
IMPORTANT - READ CAREFULLY BEFORE SIGNING
I certify that the information in this application is true, correct, and complete, and I understand that any false or misleading statements or any omissions made in completing this application or given during the Company medical examination will result in dismissal. I authorize the Company to verify the information set forth in this application and to obtain additional information relating to my background. I authorize all persons, schools, companies, corporations, credit bureaus, and law enforcement agencies to supply any information concerning my background and release all parties, including Newmont Mining Corporation, from all liability for any cause of action or damage that may result from furnishing same to the Company. I agree to conform to all Company rules and policies now or hereafter effective, and I understand that these rules and policies can be changed or discontinued without advance notice. Should I receive a conditional offer of employment, I hereby consent to a medical examination before I begin work. I also consent to pre-employment alcohol and substance abuse testing. I understand that my beginning work will be contingent upon acceptable job related results of this medical examination and acceptable results of substance abuse testing. If employed, I promise, as a condition of employment, that I will submit to the Human Resources Department verification of my U.S. employment eligibility as required by INS Form 1-9 or its successor form.
I understand that nothing in this application or in my acceptance of employment creates any contract obligation upon me or upon the Company to continue my employment in the future. I understand that my employment relationship with Newmont is ''at will'' which means my employment may be terminated by either myself or Newmont at any time without cause or notice. This ''at will'' employment relationship cannot be changed by any statement or promise unless the statement or promise is in writing and signed by Newmont's Vice-President, Human Resources.
I agree, as a condition of employment, that I may be required to be fingerprinted.
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE, INCLUDING THE ''AT-WILL" STATUS OF MY EMPLOYMENT AND THE CONDITIONAL NATURE OF ANY JOB OFFER.
Date Signed Month Day Year Signature of Applicant (Signature must be in ink, and in the handwriting of the person submitting this application.)