Date of Birth - (DDMM format)

Last 4 of SSN or National ID

Do you have a valid Driver's License?

Do you have a High School Diploma or GED?

 Can you pass the pre-employment screening process which consists of a Criminal background?

Can you pass the pre-employment screening process which consists of a Drug Screen?

Gender, Ethnicity and Race Information

Our company is an Affirmative Action/Equal Employment Employer and as such, we are required to collect and maintain information related to applicants and employees in order to meet governmental recordkeeping and reporting requirements and to monitor the effectiveness of our outreach, recruitment and other employment practices.

At this time, we are asking you to help us meet our obligations by providing the information listed on the following pages.

Please note that the information will be used only in accordance with the provisions of applicable laws, executive orders, and regulations. Providing this information is voluntary and refusal to so will not result in any adverse treatment.

The information you provide will be held in strict confidence except that:

• Necessary management and supervisory personnel may be informed to ensure proper placement and to provide reasonable job accommodations:

• First aid and safety personnel may be informed to the extent appropriate, if the condition might require emergency treatment

• Government officials investigating affirmative action program compliance may have access to reported information Thank you for your cooperation in this important initiative.

"ConocoPhillips abides by the requirements of federal laws which prohibit discrimination of individuals with the following legally protected status: race, color, religion, sex, sexual orientation, gender identity, national origin, disability and protected veterans. ConocoPhillips also abides by affirmative action requirements to employ and advance in employment qualified individuals without regard to race and sex (per Executive Order 11246), disability (per 41 CFR 60-741.5(a),and protected veteran status (per 41 CFR 60-300.5(a).

What is your Gender

What is your Ethnicity

What is your Race

Are you a protected Veteran?

 Disabled Veteran

A "disabled veteran" is one of the following:

1. A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or

2. A person who was discharged or released from active duty because of a service connected disability.

Are you a disabled veteran?

 Recently Separated Veteran

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

Are you a recently separated veteran?

Active Duty Wartime or Campaign Badge Veteran

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military. ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

Are you an active duty wartime or campaign badge veteran?

Armed Forces Service Medal Veteran

An "armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Are you an armed forces service medal veteran?

Voluntary Self-Identification of Disability

We do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

• Blindness
• Autism
• Bipolar Disorder
• Post-traumatic stress disorder (PTSD)
• Deafness
• Cerebral palsy
• Major depression
• Obsessive Compulsive Disorder(OCD)
• Cancer
• HIV/AIDS
• Multiple sclerosis (MS)
• Impairments requiring the use of a wheelchair
• Diabetes
• Epilepsy
• Schizophrenia
• Muscular dystrophy
• Missing limbs or partially missing limbs
• Intellectual disability (previously called mental retardation).

Do you have a disability