Application for Employment

SECTION 1: INTRODUCTORY INFORMATION

Applicant/Your Name *

Physical Address *

City *

State *
---AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMinor Outlying IslandsMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasU.S. Virgin IslandsUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code *

Primary Phone *

E-mail Address *

SECTION 2: APPLICANT QUESTIONS

Position Desired (you may leave this blank if unsure)
---SHEET METAL MECHANICSPIPEFITTERS AND WELDERSPLUMBERSSHEET METAL SHOP FABRICATORSHELPERS

Hourly Pay Desired

Availability / Desired Start Date *

Are you eligible to work in US? *
YesNo

Are you Age 18 or older? *
YesNo

How were you referred to Adkins & Kimbrough Mechanical?

SECTION 3: EDUCATION

High school or last grade completed

Name and Address of High School *

Course of Study
AcademicTechnical/VocationalGEDOther

Number of Years Completed *

Degree / Diploma *
DiplomaCertificateGEDOtherNone

College or Technical School

Name and Address of College or Technical School

Course of Study

Number of Years Completed

Degree / Diploma / Certificate

Other School or Training

Name and Address of School or Training Program

Course of Study

Full or Partial Years Attended

Degree / Diploma / Certificate

Do you hold an OSHA 10 Hour Certification Card? *
YesNo

Are you willing to submit to a drug / criminal background screening? *
YesNo

Have you worked for Adkins and Kimbrough or J. Adkins Mechanical before? *
YesNo

If so, when?

SECTION 4: MILITARY SERVICE

Have you served in the military? *
YesNo

Branch of Service

Rank/Type of Service

Job-Related Training/Experience

The following question is asked on a voluntary basis: Are you a Service Disabled Veteran?
YesNo

SECTION 5: RECORD OF EMPLOYMENT

Most Recent Job

Current or Most Recent Employer *

Telephone *

Address *

Position Title *

Supervisor *

Start Date *

Stop Date *

Beginning Pay Rate Per Hour *

Ending Pay Rate Per Hour *

Duties *

Reason for Leaving *

Previous Employer #2

Employer or Company Name

Telephone

Address

Position Title

Supervisor

Start Date

Stop Date

Beginning Pay Rate Per Hour *

Ending Pay Rate Per Hour *

Duties

Reason for Leaving

Previous Employer #3

Employer or Company Name

Telephone

Address

Position Title

Supervisor

Start Date

Stop Date

Beginning Pay Rate Per Hour *

Ending Pay Rate Per Hour *

Duties

Reason for Leaving

SECTION 6: WORK-RELATED REFERENCES (Do not include relatives)

Reference 1

Name *

Occupation *

Contact *

Reference 2

Name *

Occupation *

Contact *

Reference 3

Name *

Occupation *

Contact *

SECTION 7: APPLICATION STATEMENT AND SUBMISSION

Please check the box to the left to acknowledge that you've read and agree to the following statements:

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Adkins and Kimbrough Mechanical, LLC to hire me. If I am hired, I understand that either Adkins and Kimbrough Mechanical, LLC or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Adkins and Kimbrough Mechanical, LLC has the authority to make any assurance to the contrary.

I attest with my electronic submission of this form that I have given to Adkins and Kimbrough Mechanical, LLC true and complete information on this application. No requested information has been concealed. I authorize Adkins and Kimbrough Mechanical, LLC to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

I understand this application will be active for a period of 45 days; after that time, if I wish to be considered for employment, I must submit a new application.

Once all required fields on this form have been completed, please click the button below to submit your application.