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Internship Application

Thank you for considering an internship at Withers Broadcasting. Please fill out the form below for consideration.

 

 

 

First Name:
Last Name:
Social Security Number:
Street Address:
City:
State:
Zip Code:
Day Phone:
Evening Phone:
E-Mail Address:
Are you 18 years old or older? :
Birth Date:
Position Desired:
Date Available :
Do you have a FCC Restricted Radio Telephone Operator Permit? :
Can you operate word/data processing? :
Do you have the ability to perform the specific job functions of the position you are applying for? :
If yes, are you able to perform these tasks with or without accommodation? :
Are you legally eligible for employment in the U.S.? :
Have you ever been convicted of a felony? :
If yes, please explain. (Conviction record is not necassarily a bar to employment. Relevant factors will be evaluated.) :
Employment History: Most recent employer:
When did you work there? :
What was your position? :
Why did you leave? :
Supervisor:
Company Number:
Employer:
When did you work there? :
What was your position? :
Why did you leave? :
Supervisor:
Company Number :
Employer:
When did you work there? :
What was your position? :
Why did you leave? :
Supervisor:
Company Number :
List Education, Training, and Experience Relevant to the position applied for: :
 
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