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Achen Becker Media Employment Application

It is the policy of Achen Becker Media not to discriminate in its employment and personnel policies because of a person’s sex, age, race, religion, color, marital status, sexual orientation, citizenship status for legal residents, disability or national or ethnic origin or other protected classes.

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Are you legally eligible to work it the United States?(Required)

Yes

**All applicants will be required to furnish proof of identity and legal work authority within 3 business days of hire.

Do you have a valid driver’s license to operate an automobile in this state?(Required)

Yes

Driver’s License Number:

Are you insurable at standard rates to operate an automobile in this state?(Required)

Yes

If no, explain below:

Equipment/Machines you can operate and/or licenses you hold:

Are you applying generally?(Required)

Yes

Position you are applying for:(Required)

Desired Salary

How did you learn about this specific opening with Coloff Media?(Required)

Radio Ad

Internet listing

Referral

Agency

Job Fair

Walk In

Have you ever been previously employed with this company including all acquired or affiliated companies?(Required)

Yes

If yes, enter your employment dates and locations below:

Are you available for full-time work?(Required)

Yes

If no, what days/hours are you available?

Will you work overtime (if required)?(Required)

Yes

Are you subject to any contractual restrictions that would prevent, or interfere with you accepting the position or performing the duties of this job?(Required)

Yes

Education History

High school level?(Required)

Name and location of high school:(Required)

Did you graduate?(Required)

Yes

If you attended college how many years did you attend?

Name and location of college/university:

Dates that you attended college/university:

Degree/Course of study:

Did you attend Graduate, Vocational, Technical, Business Training School?(Required)

Yes

Name and location of Graduate/Vocational/Technical/Business Training School:

Dates that you attended Graduate/Vocational/Technical/Business Training School:

Have you ever been convicted of a crime?(Required)

Yes

A positive answer will not automatically disqualify you for employment. You are not obligated to disclose sealed or expunged records of conviction or arrest.

Are you currently serving probation or deferred adjudication for any crime?(Required)

Yes

If you answered “yes” to any of the above, please explain:

Volunteer/Community Service work

Briefly describe any volunteer/community service work you have done in the past 5 years.

Employment History

List all employment in the past ten years, most recent job first.

Name of Employer:

Employer Address

Street Address Address Line 2 City State ZIP Code

Employer Phone

Supervisor name:

Position:

Duties:

Start Employment Date:

End Employment Date:

Reason for leaving:

Beginning salary:

Ending salary:

Name of Employer:

Employer Address

Street Address Address Line 2 City State ZIP Code

Employer Phone

Supervisor name:

Position:

Duties:

Start Employment Date:

End Employment Date:

Reason for leaving:

Beginning salary:

Ending salary:

Name of Employer:

Employer Address

Street Address Address Line 2 City State ZIP Code

Employer Phone

Supervisor name:

Position:

Duties

Start Employment Date:

End Employment Date:

Reason for leaving:

Beginning salary:

Ending salary:

Within the past ten years, have you been terminated or asked to resign by an employer?(Required)

Yes

If you answered "yes", please provide employer, dates and circumstances

Coloff Media contacts present & prior employers to obtain references regarding work history, conduct and suitability for employment. May we contact your present employer at this time?

Yes

References

Reference Name

Position Title, Company Name

Phone Number

# of years known

Please list 3 professional references.

Upload Attachments

Drop files here or

Accepted file types: mp3, pdf, Max. file size: 100 MB, Max. files: 3.

Attachment could include resumes, sound checks or anything else you'd like us to view or listen to. Please note we will only accept .PDF and .MP3 files.

Signature(Required)

By signing you verify and agree to all of the following; that all the information on this application is true, correct and complete. You also verify that you have not withheld any information requested by Achen Becker Media. You understand that false, misleading or omitted information with result on rejection of your application, reprimand or termination from employment, whenever discovered. You authorize Achen Becker Media and its agents to confirm all information provided on this application and attachments (including resumes) and to investigate your suitability for employment. You agree to furnish additional information if requested. You release Coloff Media and all persons and companies from any claims, liabilities or damages from obtaining or furnishing information about you. Any conditional offers of employment by Achen Becker Media is subject to successful completion of all employment requirements including but not limited to verifying employment and personal references. This application is not a job offer or employment contract with Achen Becker Media for any specified time period. If hired, your employment will be for an undetermined time period and you may resign or be terminated by Achen Becker Media at any time without notice or requirement of cause. You understand and agree that no employee or official with Achen Becker Media has any authority to alter the terms of your at-will employment through oral statements or promises. In order to be binding on Achen Becker Media, any agreement or promise that alters this policy must be in writing and signed by the head of the division. Any conditional offer of employment by Achen Becker Media is subject to successful completion of all employment requirements including but not limited to verifying employment and personal references. If employed, I agree to abide by and comply with all of Achen Becker Media policies, rules and procedures.

Date signed:(Required)

Achen Becker Media and its stations are an Equal Opportunity Employer

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Achen Becker Media Employment Application

Education History

Employment History

Achen Becker Media and its stations are an Equal Opportunity Employer

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