Employment Application Date of Application____/____/____
Full Name: _________________________________________________________________
Last
First
Middle
Present Address: ____________________________________________________________
City: ____________________________ State: _______ Zip Code: _________
Phone #: (_____) ___________________
Social Security #: ___________________________
Have You Ever Worked Under a Different Name? □Yes □ No
If Yes, Previous Name Worked Under: ____________________________________________
Driver’s License Number: (If Required By Job) ___________________________State _____
Position Applying For: ___________________________________________________________________
Date Available for Work: ____/____/____
Type of Employment Desired: □Full time □Part Time □Temporary □Internship
How Did You Hear About This Job? Please Name Specific Source: _______________________________
______________________________________________________________________________________
Best Time to Call You at Home: _____________May We Contact You at Work? □Yes □No
If Yes, Work Number (_____) ______________ Best Time to Call: ________________________________
Have You Ever Been Employed by Journal Broadcast Group, Inc. Before? □Yes □No
If Yes, Department: ____________________________ Dates: ____/____/____ to ____/____/____
Have You Been Convicted of a Crime, Plead Guilty to a Crime or Entered a No-Contest Plea to a
Crime? □Yes □No
If Yes, Please explain: ___________________________________________________________________
_____________________________________________________________________________________
PREVIOUS EMPLOYMENT RECORD (List your 4 most recent employers, starting with the most recent.)
Employer: ____________________________________________ Phone #: (_____) ________________
Address: ____________________________________________________________________________
Job Title: _______