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Employment Application Employment Application 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. EMPLOYMENT APPLICATION   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: WORK EXPERIENCE (cont.): 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_________________

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