Job Opening Form Application Name First Last Date of Birth MM slash DD slash YYYY Home 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 Home PhoneCell PhoneEmail Position that you are applying for: Salary desired Why do you want to work in radio?Employer: Telephone Address Street Address City State / Province / Region ZIP / Postal Code From: To: Job Title Salary What were your duties?What did you like best about this job?Why did you leave?Employer: Telephone Address Street Address City State / Province / Region ZIP / Postal Code From: To: Supervisor Job Title Salary What were your duties?What did you like best about this job?Why did you leave?Employer: Telephone Address Street Address City State / Province / Region ZIP / Postal Code From: To: Supervisor Job Title Salary What were your duties?What did you like best about this job?Why did you leave?High School Name of School/Location Completed? Name of School/Location Dates Attended Degree/Major Completed? Other Name of School/Location Dates Attended Degree/Major Completed? Other Name of School/Location Dates Attended Degree/Major Completed? What is the most important thing you have ever learned and how has it changed your life?What one thing makes you stand out over all the rest? Why should we hire you rather than Applicant X?What are your greatest strengths - the things about you that cause you the greatest pride?What are your greatest wakenesses, the things about yourself that you could benefit the most from working to improve (It's okay to have weakenesses!)Name your favorite type of music:Are you seeking full-time or part-time employment? If hired, when would you be able to start? Are you a U.S. citizen/national? If no, are you eligible for employment in the U.S.? Have you ever been convicted of felony? If yes, please give reason and date of conviction Please indicate hours you could work on a regular basis each day of the week, including weekends:I get along well with most people Yes No Last Question: What ONE word describes you best and why did you choose that word?By signing this application, I certify that everything in it (and accompanying resume, if any) is true to the best of my knowledge. I understand that if I falsify or omit any information it will disqualify me from further consideration and will terminate my employment if discovered at a later date. I understand that my employment can be terminated at any point, with or without cause, by either the company or myself. I authorize persons, schools, current and previous employers and organizations named in this application to provide relevant information that may be required to arrive at an employment decision. I understand that filling out this application does not indicate that there is a position open and does not obligate Withers Broadcasting to hire me. If hired, I agree to abide by company work rules, policies and procedures and recognize that company retains the right to revise policies or procedures, in whole or part, at any time. I understand that Withers Broadcasting is an Equal Opportunity Employer and does not discriminate against any employee or applicant because of age, religion, race, sex, color, national origin, disability, non job-related handicap, or because they are a disabled veteran. if you believe your equal employment rights have been violated, you may contact the Federal Communications Commission, the Equal Employment Opportunity Commission or the appropriate local EEO agency. TYPE YOUR NAME AND TODAY'S DATE.*
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