Application for Employment -

Applicants requiring reasonable accommodation for the interview process should notify Human Resources.

Today's Date *

Last Name *

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First Name *

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Middle Name *

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Address *

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City / Town *

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State *

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Postal Code *

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Home Phone

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Mobile Phone *

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Email Address *

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Referral Source:

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(How did you hear about us?)

Position Desired: *

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Salary Desired: *

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Start Date: *

Type of Employment Desired: *

Full-Time

Part-Time

Temporary

Internship

If you are under age 18, can you furnish a work permit? *

Yes

If you are under 18, explain how you could furnish a work permit:

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Are you employed? *

Yes

Have you ever been employed with us? *

Yes

Give dates for previous employment with us:

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Driver’s license number if driving is required in position for which you are applying: *

Include State of issue. (Your license must be valid and in good standing. Factors such as DWI/DUI offenses will determine your continued employment.)

Have you ever plead guilty or been convicted of a crime? *

Yes

If yes, give details:

Answering “yes” to the question above does not constitute automatic bar to employment. Factors such as nature & seriousness of offense & position applied for will be taken into account

Employment History 1 *

Please list: Name & Address of Employer, Telephone #, Dates Employed, Job Title, Immediate Supervisor & Title, and Why Did You Leave?

Employment History 2 *

Please list: Name & Address of Employer, Telephone #, Dates Employed, Job Title, Immediate Supervisor & Title, and Why Did You Leave?

Employment History 3

Please list: Name & Address of Employer, Telephone #, Dates Employed, Job Title, Immediate Supervisor & Title, and Why Did You Leave?

Educational Background: *

Please list: Name & Location of School Attended, Major/Minor, Degree, # of Years Attended

Completed? *

Yes

Educational Background 2: *

Please list: Name & Location of School Attended, Major/Minor, Degree, # of Years Attended

Completed? *

Yes

Educational Background 3:

Please list: Name & Location of School Attended, Major/Minor, Degree, # of Years Attended

Completed?

Yes

References: *

Please list: Name, Title, Relationship, Telephone #, and # of Years Known

References 2: *

Please list: Name, Title, Relationship, Telephone #, and # of Years Known

References 3:

Please list: Name, Title, Relationship, Telephone #, and # of Years Known

Computer Skills: (Please check all that apply) *

Word

Power Point

Excel

Outlook

APPLICANT STATEMENT *

By clicking this box I certify that all information I have provided in order to apply and secure work with this employer is true, complete, and correct.
I expressly authorize, without reservation, the employer, its representatives or agents to contact and obtain information from all references (personal & professional), other employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive all rights and claims I may have regarding the employer, its agents or representatives, for seeking and gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons and organizations furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of eliminating me from
consideration for employment based on applicable federal, state, and local laws. If I am hired, I understand that I am free to resign at any time, with or with out cause and with or without prior notice, and the employer reserve the right to terminate the employment relationship except as may be required by law. This application does not constitute an agreement or contract for employment for any specified time.
I understand that if I am hired, I will be required to provide proof of identity and eligibility to work in the United States, and that federal immigration laws require me to complete an I-9 form in this regard.
I understand that any information provided by me that is found false or misrepresented will be sufficient cause to eliminate me from further consideration or may result in my termination, whenever it is discovered.
I certify that I have read, fully understand, and accept all terms of the foregoing applicant statement.

Name *

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This can be left alone:

Pamal Broadcasting

Application for Employment

Equal Opportunity Employer