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Valley Newspapers.org
INDEPENDENT NEWSPAPERS, INC.
EMPLOYMENT APPLICATION

Date of Application






Last Name
First Name
Middle Name
Email Address
If any of your educational or employment records are under any name(s) other than that shown above, please provide the name(s) under which these records may be located: (500 character max)
Street Name
Apt
City
State
​Zip/Postal Code
Home Phone
Secondary Phone
Have you reached your 18th birthday?
Were you previously employed by Independent Newspapers, Inc.?                       If "Yes," please give dates of employment and location(s)
Have you previously applied for employment to Independent Newspapers, Inc.?                        If "Yes", please give date(s) and location(s)
Are you a U.S. Citizen, Permanent Resident, Temporary Resident, Applicant for Temporary Residence, or Refugee?
Have you ever been convicted of a felony?                        Be advised, you are not obligated to disclose sealed or expunged records of convictions or arrest. Failure to disclose a conviction or indictment and/or mischaracterization of a conviction or indictment automatically will result in your ineligibility for employment and/or termination of employment, even if the conviction or indictment would not have resulted in your ineligibility for employment had it been properly disclosed.)
If "Yes", please explain the circumstances in full detail, including date(s), location(s), and the nature of the offense(s).
Please identify any relatives or friends currently employed by Independent Newspapers, Inc., indicating job title and place of employment.
Are you able to perform the essential functions of the job for which you have applied for?
If a reasonable accommodation is required to enable you to perform the job properly and safely, please also describe in the space provided:
Position Applying For:
How did you learn about this employment opportunity?
Employment Status Desired (Check all that apply):
Are you available to work weekends?
Are you available for overtime?
Are you employed now?
If so, Date available (MM/DD/YYYY)
Salary/Wages Desired
School
Name and Location of School
Course of Study
Years Completed
Did you Graduate?
Date of Diploma or Degree
High School
College or University
College or University
Trade or Business School
Training in Specialty Areas
Graduate or Professional School
Address of Training Program
Do you hold professional licensure/registry/certification?
If yes, please provide particulars:

Describe any other education, training, skills, language proficiencies, or certificates you possess which are relevant to the position for which you have applied:
List all methods, techniques, equipment and computer software applications with which you are proficient and which are relevant to the job for which you have applied:
Starting with current or most recent, list all employers past and present. Include self-employment and summer and part-time jobs.
​Current or Most Recent Employer
Company Name
Telephone
Type of Business
Street Address
City
State
May We Contact?
Zip/Postal Code
Employed
Base Pay (Annual):  Start $                         End $
Name and Title of immediate Supervisor
Date Hired
Date Separated
Reason for Leaving
State Current/Last Job Title and Describe Your Work:
Significant Job-Related Accomplishments: (500 character max)
Second Previous Employer
Company Name
Telephone
Type of Business
Street Address
City
State
Zip/Postal Code
May We Contact?
Employed
Base Pay (Annual):  Start $                         End $
Name and Title of immediate Superviser
Date Hired
Date Separated
Reason for Leaving
State Current/Last Job Title and Describe Your Work:
Significant Job-Related Accomplishments: (500 character max)
Third Previous Employer
Company Name
Telephone
Type of Business
Street Address
City
State
Zip/Postal Code
May We Contact?
Employed
Base Pay (Annual):  Start $                         End $
Name and Title of immediate Superviser
Date Hired
Date Separated
Reason for Leaving
State Current/Last Job Title and Describe Your Work:
Significant Job-Related Accomplishments: (500 character max)
Describe any other experiences (e.g., volunteer work), qualifications, skills or abilities which you possess in addition to those you have outlined above and which you consider important to the successful performance of the job for which you are applying (you may exclude any experiences which suggest or disclose your race, color, national origin, religion, disability or other protected status).
List current and former co-workers, colleagues and/or professional acquaintances not related to you (other than those persons listed previously) who can provide first-hand knowledge of your
qualifications and abilities. Independent Newspapers, Inc. may contact these references in connection with its consideration of your credentials.
Years Known
Name
Relationship to you
Occupation and Title
Phone Number
(Include Area Code)
I certify the answers given herein are true and complete to the best of my knowledge, and I authorize the investigation of and a background checking of all statements contained within this employment application that may be necessary in arriving at an employment decision. I further understand that, in the event of my employment by Independent Newspapers, Inc., any false or misleading information given in my application or interview(s) may result in discharge. I also understand that if employed by Independent Newspapers, Inc., I will be required to abide by all company policies.

I understand any employment offer that may be extended to me by Independent Newspapers, Inc. is contingent upon my ability to satisfy the physical and mental requirements for the position offered, which may require me to submit to a drug/alcohol screening test and physical examination.

I understand this application and any subsequent offer of employment I may receive from Independent Newspapers, Inc. does not, and is not intended to, create a contract of employment or any contractual rights in favor of Independent Newspapers, Inc. I understand that any employment relationship which may arise between Independent Newspapers, Inc. and me will be an “at will relationship,” which means Independent Newspapers, Inc. reserves the right to change, modify, suspend, revoke, or terminate my employment at any time, with or without reason, and with or without notice, and that I likewise have the right to terminate my employment with Independent Newspapers, Inc. at any time, with or without notice.

Please review the information above before signing this application.    

Electronic Signature

Applicant's Signature                                                                    Date
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
Full Time
Part Time
Temporary
No
Yes
No
Yes