Application for Employment

In order to permit a check of your work and education records, should we be made aware of any change of name or assumed name that you previously used? Yes No 

If "Yes", identify the name(s) and relevant dates:

If employment is offered, can you submit a birth certificate, social security card, certificate of U.S. citizenship or verification of your legal right to work in the U.S.? Yes No 

(Pursuant to the Immigration Reform and Control Act of 1986, all applicants who receive an offer of employment must immediately complete an I-9 form and produce documentation, no later than seventy-two hours after commencement of employment, establishing their identity and authorization for employment in the United States.)

If employment is offered, can you provide personal identification such as U.S. Passport, a driver's license or photographic identification card issued by the state? Yes No 

Are you over 18 years of age? Yes No  If "No", state age:

(If "No", Employment is subject to verification that you are of legal age to work.)

Were you in the U.S. Armed Forces? Yes No  If "Yes" What branch:

Have you ever been employed by F+W Media, Inc.? Yes No 

If "Yes", When? Which location?

Educational Data

High School: State: Zip Code:

Did you graduate? Yes No  If "No", highest grade achieved:

Have you received your GED? Yes No 

College/University: Degree received:

State: Zip Code: Phone Number:

Employment Experience

Start with your present or last job, account for all periods of time, unemployment and military service included for the last 7 years.

Current Employer or Most Recent Employer:

Current employer or most recent employer marked "No" may be contacted after a job offer has been made.

Job Duties & Responsibilities:

Job Duties & Responsibilities:

Job Duties & Responsibilities:

Upload your Resume:

This is optional. Accepted file types are PDFs, text files, and Microsoft Word documents. Files must be smaller than 750KB.

Upload your Cover Letter:

Residential History

(This information is needed and will be used only in relationship to your background check, please account for the last 10 years.)

List Below Starting With The Last Previous Address First:

References

Please provide contact information for 3 professional references that are not related to you.

CRIMINAL HISTORY

Do not disclose sealed, expunged, or statutorily eradicated convictions. California applicants shall not disclose marijuana-related convictions from two or more years ago. Massachusetts applicants shall not disclose first conviction misdemeanors within the last five years for drunkenness, simple assault, speeding, minor traffic violations, or disturbance of the peace.

Have you ever been convicted of or plead guilty to a crime? Yes No 

If "Yes", please explain:

A "Conviction" will not automatically disqualify you from being considered as a candiate for employment.

Note: In many states employment will not be denied unless there is a substantial relationship between the criminal offense and the job, or if hiring would be an unreasonable risk.

ABILITY TO OPERATE A MOTOR VEHICLE OR TO TRAVEL ON THE JOB

If you are applying for a job which will involve company-related travel operating a motor vehicle, do you have a valid driver's license? Yes No 

If you do not have a valid driver’s license, please explain how you would be able to meet the travel requirements of the job.

As an Applicant, you agree to and understand the following:

I hereby affirm that the information provided in this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information, significant omissions or misrepresentations may disqualify me and may be considered sufficient justification for dismissal if discovered at a later date.

1. You must meet Minimum Age Requirements of Applicable Laws.
2. The Company may conduct investigative inquiries, which include consumer, criminal, driving and other reports. These background inquiries include information as to character, work habits, education, performance and experience along with reasons for termination of past employment from previous employers as well as verifications of current employment. By signing this application, you authorize the Company to make these investigations, and you indicate your awareness that false statements or failures to disclose information asked for on this form may be sufficient to disqualify you for employment, or if employed may result in your dismissal.
3. Your application will be kept on active file for one year, if at that time you wish to be reconsidered for employment; a new resume must be submitted.
4. Pursuant to the Immigration Reform and Control Act of 1986, all applicant's who receive an offer of employment must immediately complete an I-9 form and produce documentation, no later than seventy-two hours after commencement of employment, establishing their identity and authorization for employment in the United States. F+W Media, Inc. hires only those persons who are legally entitled to work in the United States. Every offer of employment made by F+W Media, Inc. is subject to the condition that the employee complete Part 1 of Form I-9 and show documents, provided by law and acceptable to F+W Media, Inc., to prove identity and employability. Failure to meet this condition will result in an automatic revocation of the offer of employment.
5. I understand that this employment application, any oral representations made by the Company and any other Company documents are not contracts of employment, and that any individual who is hired may voluntarily leave employment upon proper notice, and may be terminated by the employer at any time for any reason. I understand that only the President of the Company may modify the above and that such modification must be in writing and signed by the President.

It is F+W Media, Inc. policy that all personally identifiable applicant information provided be held in confidence and properly safeguarded, and that the use of such information is limited to valid business, regulatory, or legal requirements.

The above policies are subject to change at any time.

I, the applicant, by initialing below attest that I have read and understood this document and attest to the truthfulness of all statements contained herein.

Type your initials to indicate that you agree with the above statements:
Date:

F+W Media, Inc. is an Equal Opportunity Employer