Application

Personal Info
Other names by which you have been known:
Have you ever been employed by SourceMedia Group before?*
To include The Gazette, KCRG or Color Web Printers.
Please give dates:*
Position(s) held:*
Are you legally eligible for employment in this country?*
Work Visa Number, if applicable
Are you 18 years of age or older?*
Valid driver's license?*
Valid chauffeur's license?*
Have you had any driving violations in the last 5 years?*
Please give dates and nature of the violations:*
Have you ever pled guilty or no contest to, been convicted of, or received a deferred sentence with respect to any crime, other than a simple misdemeanor? (You are not required to provide information about a conviction which has been annulled, expunged or sealed by a court.)*
Note:Conviction is not necessarily a disqualification from employment, but may be considered in relation to the position for which you are applying.
Please describe in full:*

Attach Resume and Cover Letter
This is optional.
Cover Letter
Only documents with the extensions can be accepted: .doc, .docx, .txt, or .rtf.
Resume
Only documents with the extensions can be accepted: .doc, .docx, .txt, or .rtf.
Employment History
List previous employers starting with the most recent. (Minimum 1, Maximum 4)
Employer Name*
Start Date*
Ending Date
Current Employer?
- Yes
Employer Address*
Street AddressCityStateZip Code
Starting job title/Ending job title:*
Starting Salary*
Ending Salary*
Describe the responsibilities of this position:*
Name and title of Immediate Supervisor:*
Phone Number*
May We Contact?*
Reason for Leaving:*
Add another employer?
Employer Name
Start Date
End Date
Address
Street AddressCityStateZip Code
Starting job title/Ending job title:
Starting Salary
Ending Salary
Describe the responsibilities of this position:
Name and title of Immediate Supervisor:
Phone
May we contact?
Reason for Leaving:
Add a third Employer?
Employer Name
Start Date
End Date
Address
Street AddressCityStateZip Code
Starting job title/Ending job title:
Starting Salary
Ending Salary
Describe the responsibilities of this position:
Name and title of Immediate Supervisor:
Phone
May we contact?
Reason for Leaving:
Add a fourth Employer?
Employer Name
Start Date
End Date
Address
Street AddressCityStateZip Code
Starting job title/Ending job title:
Starting Salary
Ending Salary
Describe the responsibilities of this position:
Name and title of Immediate Supervisor:
Phone
May we contact?
Reason for Leaving:

Reference Information
Provide three (3) professional work-related references, exclude family and friends.
Reference #1
Name and Relationship*
Title*
Company Name*
Phone*
Reference #2
Name and Relationship*
Title*
Company Name*
Phone*
Reference #3
Name and Relationship*
Title*
Company Name*
Phone*
Referral Information
We would like to know how you heard about SourceMedia Group. Please choose an item below:
Where did you hear about this position?
- Employee
- Newspaper/Publication
- Job Fair
- Company Website
- Employment Website
- Other

All statements and information provided on my application and/or in an interview are true and correct, and no attempt has been made to conceal or withhold pertinent information. Any falsification or misrepresentation given in my application and/or interview is cause for termination in the event I am employed. I hereby authorize investigation of all statements I have made herein. I authorize the companies, or person named (including former supervisors) to give any information regarding my past employment, together with any information they may have regarding me whether or not it is on their records.
*
- I have read and agree to the above terms
Name as shown on Social Security Card:*
Initialing here acts as a confirmation of your digital signature: *
Today's Date*

High School