Job Application; Leinbach Services, Kingsport, Tennessee

Fill Out The Form Below To Apply On-Line For Any Position.

Programs, Services and Employment are available to everyone equally. Please inform the Human Resources Dept. if you require reasonable accommodation for the application or the interview.

EMPLOYMENT APPLICATION

APPLICANT DATA

Date:

Job Applied For:

Full Name:

Address 1:

Address 2:

City:

State:

Zip:

Phone:

Cell:

Social Security:

E-Mail:

Salary Required:

If you are under 18 and we require a work permit, can you provide one?

Yes No

Have you ever worked for this company before? Yes No

Are you a United States citizen? Yes No

What type of work are you looking for?

Full Time Part Time Seasonal Temporary

Are you legally allowed to work in the U.S.?

Yes No

Have you ever been convicted of a crime?

Yes No

If yes,
please explain:

Driver's Lic. #

State of license

Who referred you to us?

EDUCATION

High School

Location

Years Completed

Did You Graduate?

Yes No

Class Rank

GPA

College/University

Location

Years Completed

Did You Graduate?

Yes No

College Degree/Major

GPA

Other

Location

Years Completed

Did You Graduate?

Yes No

Area of Study

GPA

REFERENCES

Please supply us with the names, addresses and phone numbers for two people who are not members of your family, nor have been past employers.

Reference Name One

Address

City:

State:

Zip:

Phone:

SUMMARIZE YOUR SPECIAL SKILLS OR QUALIFICATIONS

Special Skills

PREVIOUS EMPLOYMENT (begin with the most recent)

Last Job Start Date

Last Job End Date

Name of Firm

Position Held

Name of Supervisor

Title of Supervisor

Phone

Salary Earned

May We Contact Them?

Yes No

Reason for Leaving

Prior Job Start Date

Prior Job End Date

Name of Firm

Position Held

Name of Supervisor

Title of Supervisor

Phone

Salary Earned

May We Contact Them?

Yes No

Reason for Leaving

Third Job Start Date

Third Job End Date

Name of Firm

Position Held

Name of Supervisor

Title of Supervisor

Phone

Salary Earned

May We Contact Them?

Yes No

Reason for Leaving

AUTHORIZED ELECTRONIC SIGNATURE

I certify that my answers are true and complete to the best of my knowledge. I hereby authorize Leinbach Services Inc. to make such investigations and inquiries regarding personal, employment, educational, financial, or medical history or other related matters as may be necessary for an employment decision. I hereby release all employers, schools, or persons from any and all liability when responding to inquiries made in connection with this employment application.

I understand that if employed, any false or misleading information given in this application or at any interview(s) may result in discharge.

I also understand that when I enter my name below, that this constitutes a legal signature for purposes of this application.

Authorized Electronic Signature

Leinbach Services Inc.| Kingsport 423-239-3147 | Bristol 423-764-0126 | Johnson City 423-282-4983
Abingdon, VA 276-628-3975
4924 Fort Henry Dr. Suite G Kingsport, TN 37663