To Applicant:
We deeply appreciate your interest in our organization. Thank you for taking the time to complete this application.
The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national origin. Federal law also prohibits other types of discrimination such as age, citizenship, disability, veteran status, attainment of benefits, and participation in union activities. The laws of most states and many localities also prohibit some or all of the above types of discrimination as well as some additional types including, but not limited to, discrimination based upon ancestry, marital status, parental status, sexual orientation, or source of income. The fair Credit Reporting Act imposes restrictions with respect to credit data.
This list, however, is not exhaustive of the grounds on which discrimination is prohibited.
Personal Information
Date:
First Name:
Middle Initial:
Last Name:
Address:
Address 2:
City:
State:
Zip:
Phone:
E-mail:
Are you legally eligible for employment in the U.S.A.?
Yes
No
If hired, you are required to submit proof of your eligibility to work in the U.S.A.
Are you over the age of eighteen?
Yes
No
Position(s) applied for:
Where did you hear about United Radio?
Are you looking for full time or part time?
Part Time
Full Time
Were you previously employed by us?
Yes
No
If yes, when?
If your application is considered favorably, on what date will you be available for work?
Are there any other job related experiences, skills, or qualifications which will be of special benefit in the job for which you are applying?
Record of Education
Name and Address of Elementary School:
Name and Address of High School:
Indicate last year completed:
1
2
3
4
Did you graduate high school or equivalent?
Yes
No
List Diploma/Degree or equivalent:
Name and Address of College:
Indicate last year completed:
1
2
3
4
Did you graduate?
Yes
No
List Diploma or Degree:
Name and Address of Other School:
Indicate last year completed:
1
2
3
4
Did you graduate?
Yes
No
List Diploma or Degree:
Employment History
(List present and past employment, beginning with your most recent)
Name and Address of Company and Type of Business:
Employed From:
Employed To:
Starting Weekly Salary:
Ending Weekly Salary:
Phone Number of Company:
Name of Supervisor:
Describe the work you did:
Reason for leaving:
Name and Address of Company and Type of Business:
Employed From:
Employed To:
Starting Weekly Salary:
Ending Weekly Salary:
Phone Number of Company:
Name of Supervisor:
Describe the work you did:
Reason for leaving:
Name and Address of Company and Type of Business:
Employed From:
Employed To:
Starting Weekly Salary:
Ending Weekly Salary:
Phone Number of Company:
Name of Supervisor:
Describe the work you did:
Reason for leaving:
Name and Address of Company and Type of Business:
Employed From:
Employed To:
Starting Weekly Salary:
Ending Weekly Salary:
Phone Number of Company:
Name of Supervisor:
Describe the work you did:
Reason for leaving:
Personal References
(Not former employers or relatives)
Name and Occupation:
Address:
Phone:
Name and Occupation:
Address:
Phone:
Name and Occupation:
Address:
Phone:
Contact Questions
May we call you to follow up on this application at home?
Yes
No
If yes, what is the best time to call?
May we call you to follow up on this application at work?
Yes
No
If yes, what is the best time to call?
Business Phone Number:
