Submit Employment Application

Personal Information
First Name:
Last Name:
M.I.:
Social Security #:
Address:
City:
State:
Zip:
Home Phone: () -
Cell Phone: () -
Are you 16 yrs or older:
Have you been convicted of a crime, or are there any felony chares pending against you:
If yes, Explain:
Source that you were referred by:
Do you have your own transportation to/from work:
Do you have a driver's license:
Are you currently employed:
Have you had prior broadcast experience:
Are you familiar with WLJC:
If yes, explain:
Education
High School Name and Location:
Year Graduated:
College/Vocational Name and Location:
Year Graduated:
Other Education Name and Location:
Year Graduated:
List all Computer skills and programs in which you are proficient:
How many wpm can you type:
Employment History
Company Name:
Company Address:
Company Phone: () -
Supervisor:
Date Employed From:
Date Employed To:
Job Title:
Duties:
Hrs worked:
Wage:
Reason for Leaving:
Employment History 2
Company Name:
Company Address:
Company Phone: () -
Supervisor:
Date Employed From:
Date Employed To:
Job Title:
Duties:
Hrs worked:
Wage:
Reason for Leaving:
Total hours you are available to work per week:
Are there any days or hours you cannot work:
Position Desired:
Wage Desired:
Date Available:
Reference 1
  Do not list relatives
Reference 1 Name:
Address:
Phone: () -
Relationship:
Reference 2
Reference 2 Name:
Address:
Phone: () -
Relationship:
Reference 3
Reference 3 Name:
Address:
Phone: () -
Relationship:
Comments:
I certify that the statements I have made are true and I authorize the licensee to investigate the accuracy and completeness of the information provided.
Signature of Applicant:
Date: