*Fields labled with asterisks are required

*Last Name:		*First Name:	*M.I.:	*Social Security Number:

*Address:		*City:	*State:	*Zip:	*Telephone Number:

Position Desired:	Salary Desired:	*Date Available:	*Are you currently Employed? Yes No
			*May we contact your current employer? Yes No

*Are you a legal U.S. citizen? Yes No If not, you will be required to prove citizenship/immigration status before gaining employment.	*Have you been employed at this station in the past? Yes No	How did you come to apply with us? radio/tv ad newspaper ad agency employee other
	If yes, when?

*Have you been convicted of a felony in the past 7 years? (A conviction will not necessarily disqualify you from gaining employment.)
Yes No
If yes, please explain:

Name of Employer *List at least one past employer	From Mon/Yr	To Mon/Yr	Position	Supervisor	Reason for leaving

*Education*	Name of school	Location	Course of study	From Mon/Yr	To Mon/Yr	Graduated?
High School						Yes
High School						No
Business/ Technical						Degree In?
College						Degree In?
Graduate						Degree In?

Add your Resume
Please use this field to add your resume. Copy and paste your resume or type it in. Some of the formatting will be lost in this process.

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.

Applicant's Signature_______________________________Date:______________

Signature is not expected at time of submission, however your signature will be required if you are called for an interview.