Queen City's Employment Application

Applicants are required to answer each and every question accurately and completely. Applications which are incomplete or missing responses will not be considered. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, veteran status or genetic information. It is our intention that all qualified applicants are given equal opportunity and that selection decisions are based on job-related factors.

Application Date

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Home Phone*

Alternate/ Cell Phone

Email*

Will you be available to work full time?*

Yes

Will you work overtime if needed?*

Yes

Will you be able to work weekends?*

Yes

Pay Required

Position Desired

Date available to start work

Are you 18 years or older?*

Yes

Are you eligible to work in the U.S.?*

Yes

Have you applied for employment with us before?*

Yes

If yes, list month and year of application.

Have you ever worked for our company before?*

Yes

If yes, list position and dates of employment.

Do you know anyone that works for our company?*

Yes

If yes, please give name(s).

Education

High School: Name and Location

High School: Number of Years Completed

High School: Did you graduate?

Yes

College: Name and Location

College: Number of Years Completed

College: Did you graduate?

Yes

College: Degree, Diploma or Certificate

Graduate School: Name and Location

Graduate School: Number of Years Completed

Graduate School: Did you graduate?

Yes

Graduate School: Degree, Diploma or Certificate

Business/Trade/Technical: School Name and Location

Business/Trade/Technical:Number of Years Completed

Business/Trade/Technical: Did you graduate?

Yes

Business/Trade/Technical: Degree, Diploma or Certificate

Employment History

Which location(s) would you be willing to work at?

Select

Are you presently employed?

Yes

If yes, may we contact your present employer?

Yes

Please list any employers you would not like us to contact and give reason.

Are you now or do you ever expect to be engaged in any other full-time or part-time employment that would continue if you become employed by Queen City?

Yes

If yes, please explain.

Please list the three most recent and previous employers (starting with your present or most recent employer). List all employers, no matter how short the duration of employment. Account for all periods of time including military service and any periods of unemployment. If self-employed give name and supply business reference.

Company Name and Address

Job Title and Duties

Employed from______ to _______ (month & year)

Reason for Leaving

Starting salary/ Ending salary

Supervisor's name and phone number

Company Name and Address

Job Title and Duties

Employed from______ to _______ (month & year)

Reason for Leaving

Starting salary/ Ending salary

Supervisor's name and phone number

Company Name and Address

Job Titles and Dutues

Employed from______ to _______ (month & year)

Reason for Leaving

Starting salary/ Ending salary

Supervisor's name and phone number

Did you serve in the US Armed Forces?

Yes

Dates of Service?

If yes, what was the characterization of discharge

Upload Resume

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PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

I certify that all information provided in this employment application and any other material provided by me is true and complete. I understand that any false information, omission or misrepresentation on this application or any other materials provided by me may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer (except as previously noted), past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I hereby release Queen City Television Service Co., Inc. (“Queen City”), its officials, representatives and assigned agencies, including officers, employees or related personnel, both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family or associates because of compliance with this authorization and request to release. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre and/or post-employment drug screen as a condition of employment, if required. NEITHER THE ACCEPTANCE OF THIS APPLICATION NOR THE SUBSEQUENT ENTRY INTO EITHER A TEMPORARY, PART-TIME, FULL-TIME, OR ANY OTHER TYPE OF EMPLOYMENT RELATIONSHIP, REGARDLESS OF THE CONTENTS OF EMPLOYEE HANDBOOKS, PERSONNEL MANUALS, BENEFIT PLANS, POLICY STATEMENTS, AND THE LIKE, AS THEY MAY EXIST FROM TIME TO TIME, OR OTHER CUSTOMARY PRACTICES OR USAGES, SHALL SERVE TO CREATE AN IMPLIED OR ACTUAL CONTRACT OF EMPLOYMENT OR CONFER ANY RIGHT TO REMAIN AN EMPLOYEE OF QUEEN CITY OR OTHERWISE CHANGE IN ANY RESPECT THE EMPLOYMENT-AT-WILL RELATIONSHIP BETWEEN THE COMPANY AND THE UNDERSIGNED. THAT RELATIONSHIP CANNOT BE ALTERED EXCEPT BY A WRITTEN INSTRUMENT SIGNED BY THE PRESIDENT OF THE COMPANY. BOTH THE UNDERSIGNED AND QUEEN CITY MAY END THE EMPLOYMENT RELATIONSHIP AT ANY TIME, IN ACCORDANCE WITH ALL APPLICABLE STATE AND FEDERAL LAWS, WITHOUT SPECIFIED NOTICE OR REASON, AND WITHOUT LIABILITY BY QUEEN CITY TO THE UNDERSIGNED, EXCEPT FOR EARNED WAGES OR SALARY. I have read, understand, and by my signature, consent to these statements. I further certify that this application was completed by me personally and every statement herein is true.

E-Signature

Send me a copy of my responses

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