Internship Application

Thank you for considering an internship at Withers Broadcasting. Please fill out the form below for consideration.

Name*
First Last
Social Security Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Are you 18 years old or older*
Date of Birth*
MM slash DD slash YYYY
Position Desired
Date Available
Do you have a FCC Restricted Radio Telephone Operator Permit?*
Can you operate Word/data processing?*
Do you have the ability to perform the specific job functions of the position you are applying for?*
If yes, are you able to perform these tasks with or without accommodation?*
Are you legally eligible for employment in the U.S.?*
Have you ever been convicted of a felony?*
If yes, please explain. (Conviction record is not necassarily a bar to employment. Relevant factors will be evaluated.)
Employment History: Most recent employer
When did you work there?
What was your position?
Why did you leave?
Supervisor
Company Number
Employer
When did you work there?
What was your position?
Why did you leave?
Supervisor
Company Number
Employer
When 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

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