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Application for Employment
Moore Country 104, LLC is an Equal Opportunity Employer & "At-Will" Termination Employer - updated 8/8/17
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Indicates required field
Position Applied For:
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Marketing Consultant
On-Air Broadcaster
Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Date of Application
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Email
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Phone Number
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Driver's Licence #:
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Social Security #:
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Have you ever been employed here before?
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No
Yes
If "Yes", give dates and positions:
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Are you eligible for employment in this country?
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Yes
No
Desired weekly pay amount?
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Date available for work?
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Type of employment desired?
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Full-Time
Part-Time
Temporary/Seasonal
Educational/Co-Op/Internship
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?
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Yes
No
If "Yes", please provide date(s) and details
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Answering "Yes" to this question does NOT constitute an automatic bar from employment. Factors such as date, severity and nature of the violation, rehabilitation, and position applied for will be taken into account.
Employment History
Employer
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Dates of Employment
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Starting Job Title
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Final Job Title
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Immediate Supervisor
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May we contact for a reference?
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Yes
No
Reason For Leaving
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Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Hourly Rate START
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Hourly Rate FINAL
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Job Responsibilities
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Employer
*
Dates of Employment
*
Starting Job Title
*
Final Job Title
*
Immediate Supervisor
*
May we contact for a reference?
*
Yes
No
Reason for leaving
*
Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Hour Rate START
*
Hourly Rate FINAL
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Job Responsibilities
*
Employer
*
Dates of Employment
*
Starting Job Title
*
Final Job Title
*
Immediate Supervisor
*
May we contact for a reference?
*
Yes
No
Reason for Leaving
*
Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Hourly Rate START
*
Hourly Rate FINAL
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Job Responsibility
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Additional Job Experience & Skills and Qualifications
Additional Job Experience
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Skills and Qualifications e.g. training, certifications, licenses, or special skills that may qualify you as being able to perform job-related functions in the position for which you are applying
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Educational Background
High School
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Number of Years Completed
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Did You Graduate
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GED
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College
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Number of Years Completed
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Major
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Degree
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Other
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Number of Years Completed
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Course of Study
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Degree/Certification
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References
Name 1
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Relationship 1
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Phone 1
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Number of Years Known 1
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Name 2
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Relationship 2
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Phone 2
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Number of Years Known 2
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Name 3
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Relationship 3
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Phone 3
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Number of Years Known 3
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Upload Resume'
Resume'
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Max file size: 20MB
Signature
I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired. I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to request and receive such information. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me. I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself. Moore Country 104, LLC and it representatives certify that none of the information collected from this application will be shared outside of company hiring processes without the express permission of the applicant.
By typing your name you certify that all of the aforementioned information is correct to the best of your knowledge.
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Date
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