Employment Application
Antelope
An Equal Opportunity Employer
P.O. Box 4050
37404 Sierra Highway
Palmdale, CA 93590-4050
(661) 273-2700
Date Applied
–
–
PERSONAL
DATA
PLEASE ANSWER. PRINT ALL ANSWERS YOURSELF. DO NOT TYPEWRITE.
Last Name
First Name
Street Address
City
Phone Number
(
)
Are you at least 18 years of age?
–
Yes
Position(s) Applying for
EMPLOYMENT INFORMATION
Middle Initial
No
State
Do you have a relative currently employed by the Antelope Valley Press?
Yes Name
Employment Desired (check one)
Full-time
If previously employed by us, give dates.
Job Title
No
Part-time
Dept
Temporary
Reason(s) for leaving
All jobs are available to qualified candidates of either sex.
Are you willing to work the following?
Are you able to perform the tasks of the job
for which you are applying?
TYPE OF WORK DESIRED
Weekends
Yes
No
Yes
No
Clerical
Indoor
Holidays
Yes
No
Typing (wpm)
Outdoor
Shifts & Rotation
Yes
No
Mechanical
Either
Overtime
Yes
No
Technical
Other
If hired, on what date will you
be available to start work?
Driver’s License #
State
Exp. Date
Traffic violations in the last 3 years?
Yes
No
Convicted of a felony or for
Traffic accidents in the last 3 years?
Yes
No
convictions that are sealed,
Convicted of driving under the influence of alcohol or drugs?
Yes
No
expunged or irradicated in the last 7
years?
Yes
No
Name of High School
City
Name of College
City
Name of College
City
State
State
State
Graduate?
Yes
No
Graduate?
Yes
No
Graduate?
Yes
EDUCATION AND SKILLS
Zip Code
Major subjects
Major subjects
Units completed
Major subjects
Units completed
No
Are you now attending school?
What courses are you taking?
List any other courses, studies or training.
Yes
No
Part-time
Full-time
Academic
Business
General
Vocational
List any other licenses, skills, vocational training, equipment or machines operated, experience or qualifications which you feel are applicable to
employment with the Antelope Valley Press, or helpful to us in our evaluation.
List other name(s) under which school or employment records are kept:
PLEASE GIVE US YOUR EMPLOYMENT BACKGROUND
NAME
(LIST CURRENT OR MOST RECENT FIRST)
Company Name
DAY/MESSAGE TELEPHONE (
)
Job Title or Position Held
May we contact? Yes No
Describe Your Duties/Responsibilities
Address
Supervisor’s Name
EMPLOYMENT RECORD
Telephone Number (
)
Dates of Employment
From:
Starting
Pay/Salary
Company Name
To:
Ending
Pay/Salary
Additional
Reason for Leaving
Compensation
Job Title or Position Held
May we contact? Yes No
Describe Your Duties/Responsibilities
Address
Supervisor’s Name
Telephone Number (
)
Dates of Employment
From:
Starting
Pay/Salary
Company Name
To:
Ending
Pay/Salary
Additional
Reason for Leaving
Compensation
Job Title or Position Held
May we contact? Yes No
Describe Your Duties/Responsibilities
Address
Supervisor’s Name
Telephone Number (
)
Dates of Employment
From:
Starting
Pay/Salary
To:
Ending
Pay/Salary
Additional
Compensation
Reason for Leaving
List any periods of unemployment.
From
To
From
To
From
To
From
To
CERTIFICATION
Thank you for your interest in Antelope Valley Newspapers, Inc. (AVP). We are an Equal Opportunity Employer. All employment decisions here are based on merit/qualifications and
without regard to race, sex, religion, color, national origin, age, marital status and/or disability. AVP complies with all applicable federal, state and local laws prohibiting employment
discrimination.
PLEASE READ AND INDICATE YOUR AGREEMENT TO EACH OF THE FOLLOWING
BY INITIALING THE SPACES PROVIDED BELOW
1. I authorize AVP and its representatives to verify my references and the correctness/completeness of my answers to this application. I hereby release AVP and its
representatives from any and all liability arising from or associated with any authorized inquiry. I request and authorize those listed as references herein and my prior
employers to provide AVP with information relevant to my possible employment and/or pertaining to any of the questions contained in this application. I hereby release
them from any and all liability arising from their providing information requested by AVP. Please initial indicating your agreement _____.
2. If hired, I understand and agree that my employment is and will remain for an indefinite period and “at-will.” I further agree that my “at-will” employment cannot change
unless AVP expressly agrees to that change in writing signed by President and Publisher. Please initial indicating your agreement _____.
3. I understand and agree that any offer of employment I may receive is contingent upon my taking and satisfactorily passing a drug/alcohol test to detect the presence/use
of illegal controlled substances or the misuse of prescription drugs/alcohol. If I receive an offer, I hereby consent to said test. Please initial indicating your agreement _____.
4. I acknowledge and agree that, upon my acceptance of employment, I will be required and able to provide proof of my identity and my eligibility to work in the United
States in accordance with the Immigration Reform and Control Act. Please initial indicating you agreement _____.
5. I authorize AVP to verify my driving record with the DMV. Please initial indicating your agreement _____.
If you wish AVP to consider this application, please sign it in the space provided below.
Please understand that AVP will consider your signature as your certification that you have carefully read, considered and answered each question/provision in this application and that each of
your responses to said questions/provisions are voluntary, true and correct.
Signature
PC82-3/11-2.5M
Date Signed
©2013 Antelope Valley Newspapers, Inc. All Rights Reserved.
Antelope
Consumer Credit and Background Check Report Release Form
By my signature below I hereby give permission to Antelope Valley Press, Inc.
and Collard Investigations Internationale, LLC to obtain a Consumer Credit Report
and/or Background Check Report on me. This authorization is valid for purposes of
verifying information given in connection with my application for employment covered under the Equal Employment Opportunity Act (EEOA), Fair Credit Reporting Act
(FCRA), and the Drivers Privacy Protection Act (DPPA). In addition, I understand that
Antelope Valley Press, Inc. may conduct additional background checks during my
employment if I am hired.
I also hereby authorize all corporations, former employers, supervisors, credit agencies, educational institutions, law enforcement agencies, city, state, county, and federal courts and agencies, military services, and other persons or entities with relevant
information about me, to release any and all such information only to Antelope Valley
Press, Inc. and Collard Investigations Internationale, LLC and their representatives.
This authorization shall be valid in original or facsimile form. You may contact me personally if you need to further verify and authenticate this request.
Applicant’s Name:
Last
First
Middle
Other Names Used:
Address:
Suffix (Sr., Jr., III, etc.)
Telephone #:
(Maiden, Nickname, etc.)
Social Security #
(Area Code) Number
Street
City
Drivers License #
Home E-mail Address:
Applicant’s Signature:
State
Zip
Date of Birth:
(For Criminal Check Only)
State Issued Expiration Date
(For Confidential Communication Only)
Date Signed:
Additional Comments:
PC83-1/13-2M
©2013 Antelope Valley Newspapers, Inc. All Rights Reserved.