Shalom Media USA, Inc.

211 E Wisconsin Rd, Edinburg, TX 78539

phone: (215) 366-3031 | email: info@shalomworld.org

EMPLOYMENT APPLICATION
Shalom Media USA Inc. is an Equal Opportunity Employer. Qualified applicants for employment will be considered without
regard to race, color, religion, gender, nationality and disability.

INSTRUCTION TO APPLICANTS
The Application form should be fully completed in order to be considered for consideration.Application form will not replace the
resume. Please also upload a detailed resume.

Name:
LAST FIRST MIDDLE

Are you over 18 years of age? : Phone:

Address: Cell:

Date available to start work:

Position Desired: Full Time Part Time Temporary

Are you willing to travel? Yes No If yes, what percentage of time:

Has a Catholic institution or ministry ever employed you? Yes No

If yes, give details:

How did you hear of this opening? Shalom Publication Company Website
Employee Referral Job Board

If hired, are you eligible to work in the U.S? Yes No

Have you ever plead guilty to or been convicted of any criminal offense, other than minor traffic citations? Yes No

If yes, provide information on criminal offense, date, location (city, state) and disposition.

US Military Service:
BRANCH OF SERVICE DATE FROM TO

Your personal information will be kept Confidential

EDUCATION

GRADUATE COURSE YEAR

TYPE NAME & LOCATION
YES/NO OR DEGREE GRADUATED

High School

College

Graduate School
Business/Vocational
Trade school
Other Skills and
Training

EMPLOYMENT HISTORY
Complete the following information beginning with the most recent employment

Employer Name & Address: From: m m / d d / y y To:

Phone:
Position: Name & Title of Supervisor:
Full Time/Part Time: Salary: Email:
Brief Description of Duties:

Reason for leaving:

Employer Name & Address: From: m m / d d / y y To:

Phone:
Position: Name & Title of Supervisor:
Full Time/Part Time: Salary: Email:
Brief Description of Duties:

Reason for leaving:

Employer Name & Address: From: m m / d d / y y To:
Phone:
Position: Name & Title of Supervisor:
Full Time/Part Time: Salary: Email:
Brief Description of Duties:

Reason for leaving:

Please explain in detail what attracts you to join Shalom Media as an employer:

Person to be notified in case of emergency:

Name: Address:

Phone #

Relationship to you:
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND INDICATE YOUR UNDERSTANDING AND
ACCEPTANCE BY SIGNING THE SPACE PROVIDED.

I understand that all of the information on this application, exhibits and resume submitted to Shalom Media USA, Inc. is
true, correct and complete. I understand that false, misleading, incomplete or omitted information will result in the
rejection of my application or if hired, termination of my employment.

I authorize Shalom Media to conduct any investigation respect to any information provided above. I authorize any former
employer, present employer, school, college, university credit or finance bureau, personal reference or any other person to
give any information they may have concerning my employment, education, certification, licenses, character, criminal
record, driving, credit or any other information of any kind and I release all such parties from all liability from any damages
which may result from furnishing such information.

I understand that if employed, I will be required to follow the personnel policies, rules and regulatory requirements
governing the organization and that infraction of such may lead to my discharge. I understand that as a condition of
employment, I will be required to provide legal proof of authorization to work in the U.S. I agree to undergo any type of
drug and/or alcohol testing that the Company may require at any time. Finally, I understand that submission of this
application does not necessarily mean that I will be hired, and that if I am hired, my employment will be at will, and either
I or the Company may terminate my employment at any time, with or without notice or reason.

SIGNATURE

DATE

THIS ORGANIZATION PARTICIPATES IN E-VERIFY