WXXV25 Employment Application Form Step 1 of 4 25% Your Personal InformationYour Name First Middle Last Your Email Address Enter Email Confirm Email Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your PhoneAlternate PhoneBest Time To Call YouWhen is the best time for us to reach you via telephone?Best Time To Call YouMorningsEarly AfternoonLate AfternoonEarly Evening Employee InformationPosition Applying For: Are you able to perform the essential functions of the position with or without accommodations? Yes No If necessary for the job, I am able to work overtime? Yes No Provide a valid Driver's License? Yes No If so, fill out the following: Issuing state: AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State I am legally eligible for employment ln the U.S.? Yes No I am seeking a permanent position: Yes No Work the following shifts: (check all that apply) Any Day Night Swing Rotating Split Graveyard Other Hours You Are Available for WorkPlease tell us what hours you are available for work each day of the week. (ex. 8am-5pm)MondayTuesdayWednesdayThursdayFriday Add RemoveEmployment HistoryYour Previous EmployersPlease list your previous employers, the dates you worked and the position you heldEmployerAddressPay RateStart DateEnd DatePositionSupervisorPhoneReason For Leaving Add RemoveEducationHigh school College/university Business/technical AdditionalHigh school College/university Business/technical AdditionalInstitution NameYears Completed (ex. 2008-2012)Field Of StudyGraduate Or Degree Add Remove MilitaryAre you a veteran? Yes No SKILLS & QUALIFICATIONSOther qualifications such as special skills, abilities or honors that should be considered: Types of computers, software, and other equipment you are qualified to operate or repair: Professional licenses, certifications or registrations: Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employer's attention: Typing speed (per minute) ReferencesReferencesList two personal references who are not relatives or former supervisors.NameAddressTelephoneOccupationYears Known Add RemoveContactsIn case of accident or illness, please contact:NameDaytime TelephoneAddressRelationship Add RemoveINFORMATION TO THE APPLICANTUpload Your ResumeUpload your resume in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 100 MB.Signature(Required)As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for Information derived from the checking of your references. If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and agree to the information shown above. ·By signing your name electronically on this WXXV25 Job Application Form, you are agreeing that your electronic signature is the legal equivalent of your manual signature on this form. Date MM slash DD slash YYYY Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information Is optional and failure to provide it will have no effect on your application for employment.PhoneThis field is for validation purposes and should be left unchanged.