Complete the below and mail or drop by: 1116 Ocala Street, Myrtle Beach, SC 29577. When printing, be sure to set your printer to landscape view.
NEXTMEDIA OPERATING, INC.
APPLYING FOR:
Job Title___________________________________Availability to Start____________
Location________________________________________________________________
HOW DO WE CONTACT YOU?
Your Name__________________________Social Security Number_____-____-_____
Mailing Address_________________________________________________________
City____________________County_______________State______Zip Code________
Phone Number____________________Home _____________________________Cell
TELL US ABOUT YOUR EDUCATION:
High School (Name)____________________________Location___________________
College Graduate (Yes/No) If no, give total credit received____________
Give name, address of school, major course of study, and degree received.
Job-Related Training and Course Work
List skills, licenses, and certificates which are related to the job you seek (including works per minute typing speed, and computer software proficiency):
TELL US ABOUT YOUR WORK EXPERIENCE:
Describe your work experience in detail, beginning with your current or most recent job. Include military service and job related volunteer work, if applicable. Provide an explanation for any gaps in employment. A resume may be attached, but not substituted for completing this section.
Name of Present or Last Employer__________________________________________
Address__________________________________________Phone_________________
Job Title_________________________________Number Supervised______________
Supervisor’s Name_______________________________________________________
From_____/_____/_____ To____/_____/___Hours per Week_______Pay__________
May we contact this employer? Yes/No
Job Duties (give details):
Reason for Leaving:
Your Next Most Recent Employer__________________________________________
Address__________________________________________Phone_________________
Job Title_________________________________Number Supervised______________
Supervisor’s Name_______________________________________________________
From_____/_____/_____ To____/_____/___Hours per Week_______Pay__________
May we contact this employer? Yes/No
Job Duties (give details):
Reason for Leaving:
Your Next Most Recent Employer__________________________________________
Address__________________________________________Phone_________________
Job Title_________________________________Number Supervised______________
Supervisor’s Name_______________________________________________________
From_____/_____/_____ To____/_____/___Hours per Week_______Pay__________
May we contact this employer? Yes/No
Job Duties (give details):
Reason for Leaving:
Your Next Most Recent Employer__________________________________________
Address__________________________________________Phone_________________
Job Title_________________________________Number Supervised______________
Supervisor’s Name_______________________________________________________
From_____/_____/_____ To____/_____/___Hours per Week_______Pay__________
May we contact this employer? Yes/No
Job Duties (give details):
Reason for Leaving:
Your Next Most Recent Employer__________________________________________
Address__________________________________________Phone_________________
Job Title_________________________________Number Supervised______________
Supervisor’s Name_______________________________________________________
From_____/_____/_____ To____/_____/___Hours per Week_______Pay__________
May we contact this employer? Yes/No
Job Duties (give details):
Reason for Leaving:
Your Next Most Recent Employer__________________________________________
Address__________________________________________Phone_________________
Job Title_________________________________Number Supervised______________
Supervisor’s Name_______________________________________________________
From_____/_____/_____ To____/_____/___Hours per Week_______Pay__________
May we contact this employer? Yes/No
Job Duties (give details):
Reason for Leaving:
PERSONAL INFORMATION
Do you possess a driver’s license? (Yes/No)
If yes, please provide the following information:
State___________________Number________________Expiration Date___________
Do you have transportation to and from work? (Yes/No)
Have you ever been convicted of a criminal offense? (Yes/No)
If yes, what were the charges? Please explain. (Note: A criminal conviction will not necessarily be a bar to employment. Any relevant factors such as age at time of the offense, the seriousness and nature of the violation, and rehabilitation will be taken into account. Any such matter should be fully explained below. Attach a separate sheet of paper if necessary.)
Have you ever been terminated or forced to resign from any job? (Yes/No)
If yes, please explain______________________________________________________
Are you legally authorized to work in the United States? (Yes/No)
Person to Notify in Case of an Emergency____________________________________
Relationship_______________________________Phone Number_________________
