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* Last name:
* First name:
* Middle initial:
* Address:
* City:
* State:
* Zip Code:
* E-Mail address :
*Home telephone number :    
*Business telephone number :    
*Social Security number :    
Have you reached your 18th birthday?  Yes   No 
Were you previously employed by Independent Newspapers, Inc.?  Yes   No 
If Yes, please give dates of employment and location(s)
Have you previously applied for employment to Independent Newspapers, Inc.?  Yes   No 
If "Yes", please give date(s) and location(s)
* Position applying for :
*Full time:   Part time:   Temporary until:
1: Education and Training
High School
Name of high school:   Years completed: 
Diploma/degree obtained:
Year conferred:
Undergraduate College/University:
Name of school:   Years completed: 
Diploma/degree obtained:
Year conferred:
Course of study:
Name of school:   Years completed: 
Diploma/degree obtained:
Year conferred:
Course of study:
Describe any specialized training or education, apprenticeship, volunteer work, skills or extracurricular activities which you feel are relevant to the job for which you are applying:
Describe honors or awards you have received that you regard as relevant to the job for which you are applying:
State any additional information you feel may be helpful to us in considering your application for employment:
2. License and citizenship status
A vehicle is required for some positions:
Do you have access to a car?Yes   No
Do you have a valid driver's license?Yes   No
Are you an insured driver?Yes   No
Are you a U.S. Citizen, Permanent Resident, Temporary Resident, Applicant for Temporary Residence, or Refugee?Yes   No
If you are not a United States citizen, do you have an Entry Permit which allows you to work?Yes   No
Have you ever been convicted of a felony? Yes   No 
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?  Yes   No 
If a reasonable accommodation is required to enable you to perform the job properly and safely, please describe in the space below:
3. Work History
Starting with current or most recent, list all employers past and present. Include self-employment and summer and part-time jobs.
4. 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.
1) Name:
Phone number w/area code:
2) Name:
Phone number w/area code:
3) Name:
Phone number w/area code:
4) Name:
Phone number w/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.

Your name:
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