Employment Application

Thank You

Thank you for submitting your job application. We will contact you when we have an opening that meets your qualifications.

Employment Application

Please fill out as much information as possible. Certain fields are required and marked with a (*).

Applicant Information

Full Name*:
Address*:

Primary Phone*:
E-mail Address:
Secondary
Phone:
Desired Salary: $
Date Available to Start*:
Are you a citizen of the United States?*
If no, are you authorized to work in the U.S.?
Have you ever worked for this company?*
If yes, when?
Have you been convicted of a felony within the past 7 years?*
If yes, explain:
Do you have a reliable method of getting to work?*
Do you know anyone who currently works for us? If yes, list name:
How did you hear about us?

Education

High School:
Address:

Did you graduate?
Degree:
College:
Address:

Did you graduate?
Degree:
Other:
Address:

Did you graduate?
Degree:

References

Please list three professional references
Full Name:
Relationship:
Company:
Phone:
Full Name:
Relationship:
Company:
Phone:
Full Name:
Relationship:
Company:
Phone:

Work Preference

Work Preference*:
Position*:

Previous Employment

Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $

Duties:

From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $

Duties:

From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $

Duties:

From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?

Resume/CV Upload

Upload your Resume or CV!

If you wish to provide us with more information about yourself, you may upload and attach a resume or CV to this application here.

Your uploaded document must be smaller than 10MB and be in one of the following formats: TXT, RTF, PDF, DOC, DOCX, ODF

Release Disclosure and Authorization

Applicant Complete the Following

In connection with my application for employment, I understand that Atwill Media, Inc. may obtain information about me for employment purposes from a third party consumer reporting agency. An investigative employment report may be requested that will include information as to my character, work habits, performance, and experience, along with reasons for termination of past employment. Thus, I may be subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records, verification of your education or employment history, or other background checks. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained within regard to applicants for employment is an investigation into your education and/or employment history conducted by Asurint, Compliance Department, P.O. Box 14730, Cleveland, OH 44145, (800) 906-2034, www.asuriant.com/Compliance.aspx, or another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing Atwill Media, Inc to obtain from any outside organization all manner of consumer reports and investigative consumer reports and investigative consumer reports now and throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

I acknowledge that a facsimile (FAX), electronic, or photographic copy of this Authorization shall be as valid as the original.

I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contacted by Atwill Media, Inc. or its agent, to furnish the information described in Section 1.

It is our policy that we do not discriminate on the basis of race, national origin, creed, veteran status, religion, age, gender, sexual orientation or disability and to provide Equal Opportunity Employment. We appreciate your cooperation.

I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those items. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by Atwill Media, Inc at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university, information service bureau, employer, or insurance company to furnish any and all background information requested by Asurint, Compliance Department, P.O. Box 14730, Cleveland, OH 44145, (800) 906-2034, www.asurint.com/Compliance.aspx, another outside organization acting on behalf of Atwill Media, Inc, and/or the Atwill Media, Inc itself.

The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes. I hereby release the employer and agents and all persons, agencies, and entities providing information or reports about me from any and all liability arising out of the requests for or release of any of the above mentioned information or reports.

Other names you have used (separated by commas):
Social Security Number*(only digits, no dashes):

Date of Birth*(MM/DD/YYYY):
The follwing states require sex and race to obtain information: AL, AR, FL, GA, IA, IL, IN, MI, OR, SC, TX, WI
Sex*:

Race*:

Driver's License Number*:
State Issuing License*:

Name as it appears on license*:

Disclaimer and Signature

*Please read carefully before submitting*

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate, and complete to the best of my knowledge. I understand that the falsification, misrepresentation, or omission of any fact in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by Atwill Media that such employment with Atwill Media is at will, for no specified duration and may be terminated by either Atwill Media or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of Atwill Media or its representatives used during the employment process is deemed a contract of employment real or implied.

In consideration for employment with , if employed, I agree to conform to the rules, regulations, policies, and procedures of Atwill Media at all times and understand that such compliance is a condition of employment.

I understand that if offered a position with , I may be required to submit to a pre-employment drug screening and background check as a condition of employment. I understand unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and check will result in withdrawal of any employment offer or termination of employment if already employed.

I hereby authorize any and all schools, former employers, references, courts, and any others who have information about me to provide such information to Atwill Media and/or any of its representatives, agents, or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information.

I understand that this application is consideration current for one year. If I wish to be considered for employment after this period I must fill out and submit a new application.

Atwill Media is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, veteran status, or any other status protected under local, state, or federal laws.

By signing below and submitting this form, I acknowledge that I have read, understood, and agree to the above statement.

Signature*:
Date: 2024-04-23