Personal Info

Name (Last, First, Middle)

Your Email

Social Security Number

Address

City/State/Zip

Position Desired

Salary Desired

Date Available

Home Phone

Alternate Phone

How did you learn about us?

Advertisement Recruitment firm Friend Other Current Employee Walk-in Job fair

Are you legally eligible for employment in the US?

Yes No

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

Yes No

Are any of your relatives presently employed with the company?

Yes No

If yes, name of relative:

Have you ever worked for the company before?

Yes No

If yes, where?

Dates worked?

Please indicate days and hours available

Type of employment

Full time Part time Temporary

Education

High School

Address

Number of years completed

Diploma received

Yes No

College

Location

Course of study

Number of years completed

Highest degree received

Graduate school

Location

Course of study

Degree received

Vocational or Trade School

Location

Course of study

Number of years completed

Diploma received

Additional Experience or Qualificatons

List any other experience, skills, or qualifications which you believe should be considered in evaluating your qualifications for employment.

Prior Employment

Start with your present employer or most recent position

Employer 1

Address

City/State/Zip

Phone

Employment dates (from/to)

Position

Supervisor's name and title

Hours worked per week

Starting salary/wages

Final salary/wages

Reason for leaving

May we contact this employer?

Yes No

Describe work performed

Employer 2

Address

City/State/Zip

Phone

Employment dates (from/to)

Position

Supervisor's name and title

Hours worked per week

Starting salary/wages

Final salary/wages

Reason for leaving

May we contact this employer?

Yes No

Describe the work performed

Employer 3

Address

City/State/Zip

Phone

Employment dates (from/to)

Position

Supervisor's name and title

Hours worked per week

Starting salary/wages

Final salary/wages

Reason for leaving

May we contact this employer?

Yes No

Describe the work performed

Military Service

Branch

Dates of service (from/to)

Rank/duties

Date discharged

Personal references

(Give 3 individuals - not relatives or employers

Name 1

Address

City/State/Zip

State

Zip

Phone

Occupation

Name 2

Address

City/State/Zip

Phone

Occupation

Name 3

Address

City/State/Zip

Phone

Occupation

EEOC Compliance Form

Requested information for EEO requirements of the Federal Communications Commission

Name

Date

Vacancy applied for

What prompted you to apply?

Radio Advertisement Newspaper Advertsiement LA Works - Department of Labor Agency Community Organization Station Employee Referral Non-Employee Referral School Self Professional Reference Other If other, please enter it here:

If other, please enter it here:

Please identify the referral source by name, and provide any additional contact information you know about that source or that is applicable to your situation, including address, phone, e-mail and contact person: