Employment Application


Information labeled in purple is required.  Incomplete information could disqualify you from further consideration (if you have nothing to enter into a required field, type 'none' or 'n⁄a'.)  Please include additional pages as part of your attached resume if adequate room is not provided.

  If Other, please tell us how  

 Personal Information 




Name and Location of School Last Year Completed Major Course Diploma ⁄ Degree



 Employment References 

 Employment History 

Begin with your present or most recent job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, marital status, handicap or other protected status. You may include another sheet as part of your attached resume (see above) if necessary.


(If any employment was under a different name, indicate name.)

Most Recent Employer

Previous Employer

Previous Employer

 Employment Experience 

Describe your experience/proficiency with the following:

 Additional Information 




 Invitation to Identify for Affirmative Action Purposes 

3 Rivers Communications is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, 3 Rivers invites applicants to voluntarily self-identify their gender and race or ethnicity. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including our Affirmative Action Plan. When reported, data will not identify any specific individual.


Please read carefully before submitting your application:

All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired. I authorize the company to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with me or my employment background for the purpose of verifying any information, I have provided and/or for the purpose of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment. I understand that upon receiving a job offer, a physical examination and drug screening may be required. (Note: If this is a job requirement, you will be notified.) Regardless of whether or not I become employed by the company, I recognize that this application is not and should not be considered a contract of employment. I understand that no company employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other that an officer or official of the company, and then only by means of a signed written document. We have a policy of no smoking inside company buildings or inside company vehicles.