Internship Application Thank you for considering an internship at Withers Broadcasting. Please fill out the form below for consideration. Internship Application Name* First Last Social Security Number* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Are you 18 years old or older*YesNoDate of Birth* MM slash DD slash YYYY Position Desired Date Available Do you have a FCC Restricted Radio Telephone Operator Permit?*YesNoCan you operate Word/data processing?*YesNoDo you have the ability to perform the specific job functions of the position you are applying for?*YesNoIf yes, are you able to perform these tasks with or without accommodation?*WithWithoutAre you legally eligible for employment in the U.S.?*YesNoHave you ever been convicted of a felony?*YesNoIf yes, please explain. (Conviction record is not necassarily a bar to employment. Relevant factors will be evaluated.)Employment History: Most recent employerWhen did you work there?What was your position? Why did you leave?Supervisor Company Number EmployerWhen did you work there?What was your position? Why did you leave?Supervisor Company Number EmployerWhen did you work there?What was your position? Why did you leave?Supervisor Company Number List Education, Training, and Experience Relevant to the position applied for
Mount Vernon (IL) WMIX-AM/FM | WDML | WILY | WRXX | WNSV Marion-Carbondale (IL) WFRX | WDDD | WHET | WTAO | WVZA | WEBQ-AM/FM | WQRL | WISH | WMCL Paducah (KY) WGKY | WREZ | WZZL | WMOK | WRJJ Cape Girardeau (MO) KGMO | WKIB | KREZ | KYRX | KAPE | KJXX Sikeston (MO) KRHW | KBHI | KBXB Flagstaff-Prescott (AZ) KSED | KFLX | KWMX | KBTK Withers Digital