2015 ROCK GIRL APPLICATION
# ______
CONTACT INFORMATION:
_________________________
_________________________
_______
First Name
Last Name
Middle Initial
____________________________________ _______________________
__________
Street Address
Zip Code
(
City
)
(
Main Telephone #
)
_ ________________________ ____
Secondary Phone #
E-mail Address
Facebook account?
Yes
No
If yes, please list _
____________________________________
Twitter?
Yes
No
If yes, please list _
____________________________________
Other Social Media?
Yes
No
If yes, please list _
____________________________________
Website?
Yes
No
If yes, please list _
____________________________________
/
Date of Birth
/ 19
-
-
Social Security #
PERSONAL INFORMATION:
Measurements:
Height ____’____”
Please Circle Size: Shirt Size:
S
M
Weight __________
L
Short Size:
S
M
L
Dress Size _____ Shoe Size ______
Color:
Hair ______________
Eyes
_________________
In a cut-off t-shirt and shorts, if you have any visible tattoos, please list ___________________________________
Have you ever been employed by any media company? Yes
No
If yes what company __________________________________
From
Do you currently have representation by a model or talent agency? Yes
/
/
to
Do you hold a valid drivers license? Yes
No
/
No
If yes, who? _________________________________________ Type of contract? Exclusive
Are you legally eligible for employment in this country? Yes
/
Non-Exclusive
No
Will you travel if this job requires it? Yes
If they have been explained to you, are you able to meet the position’s attendance requirements? Yes
No
No
Answering “yes” to the following question does not constitute an automatic bar to employment. Factors
such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for
will be taken into account.
Have you ever pleaded “guilty” or “no contest” to, or been convicted of crime? Yes
No
If yes, please provide date(s) and details: _________________________________________________________
EMPLOYMENT HISTORY:
____________________________________________
Most Recent Employer
______________________________________
Address and City
____________________________________________
Telephone #
______________________________________
Start date/end date (or still employed there)
__________________________________________________________________________________________
Starting Job Title / Final Job Title
__________________________________________________________________________________________
Immediate Supervisor and Title
May we contact for a (for most recent position held) reference? Yes
No
Later
If you are no longer employed there, why did you leave? ______________________________________________
Summarize the type of work performed and job responsibilities. ________________________________________
___________________________________________________________________________________________
What did you like most about your position? ____________________________________________________
___________________________________________________________________________________________
What were the things you liked least about your position? _____________________________________________
___________________________________________________________________________________________
If not addressed on previous page, have you ever been asked to resign from a job?
If yes, please provide date(s) and details: _________________________________________________________
___________________________________________________________________________________________
HOBBIES & INTERESTS:
Description ____________________________________________________________________
____________________________________________________________________________
EDUCATIONAL BACKGROUND:
Provide the following information for your highest level of education
__________________________________________
School (include City and State)
_____________________
Years Completed
___________________
GPA and/or Class Rank
__________________________________________________________________
Major/Minor
Level achieved: Diploma
Other
/ Type _____________________
GED
Degree
Certification
(explain) ___________________________________________________________________________
REFERENCES:
List name and telephone number of personal references who are not related to you and are not
previous supervisors.
______________________________
_______________________
_________________
Name
Title
Relationship
____________________________________
Telephone
____________________________
Number of years known
______________________________
_______________________
_________________
Name
Title
Relationship
____________________________________
Telephone
____________________________
Number of years known
______________________________
_______________________
_________________
Name
Title
Relationship
____________________________________
Telephone
____________________________
Number of years known
RELATED INFORMATION:
List any special achievements / awards, etc. (professional / academic) ___________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Is there any other job-related / personal information you want us to know about you?
___________________________________________________________________________
___________________________________________________________________________
IMPORTANT!!!
ROCK GIRLS APPLICANTS MUST BE AVAILABLE AT THESE TIMES / LOCATIONS IN
ORDER TO BE ELIGIBLE TO WIN. DATE / TIMES / LOCATIONS SUBJECT TO CHANGE.
ROCK GIRL FINALIST PHOTO / VIDEO SHOOT AND ON-AIR INTERVIEW:
* Thu 5/28/15 from 4p-7p @ Front Room Photography - 2637 South Kinnickinnic Ave, Milwaukee, WI
53207. Information will be given to finalists. Finalists will be scheduled for a time on a first come / first
serve basis.
* Date(s) TBD between 6/1 and 6/12/15 between the hours of 3 and 6p @ THE HOG – 5407 West
McKinley Ave, Milwaukee, WI 53208. Finalists will be scheduled for a time on a first come / first serve
basis.
ROCK GIRL FINALIST EVENTS:
* Times and locations TBD from 5/29/15 - 6/18/15. A list will be provided to Finalists.
ROCK GIRL FINALE:
* Saturday, 6/20/15 from 4p-8p @ Hal’s Harley-Davidson - 1925 South Moorland Rd, New Berlin, WI
53151
APPLICANT STATEMENT:
I certify that all information I have provided in order to apply for and secure work with 102.9 THE HOG is true,
complete and correct. I expressly authorize, without reservation, THE HOG, Time Warner Cable, their
representatives, employees or agents to contact and obtain information from all references (personal and
professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify
the accuracy of all information provided by me in this application. I hereby waive any and all rights and claims I may
have regarding THE HOG, its agents, employees or representatives and Time Warner Cable, for seeking,
gathering, and using truthful and nondefamatory information, in a lawful manner, in the employment process and all
other person, corporations or organizations for furnishing such information about me.
I understand that that THE HOG and Time Warner Cable do not unlawfully discriminate in employment and no
question on this application is used for the purpose of limiting or eliminating any applicant from consideration for
employment on any basis prohibited by applicable local, state, or federal law. I understand that this application
remains current for the next full Rock Girl cycle (approximately through 6/20/15). At the conclusion of that time, if I
have not heard from THE HOG and still wish to be considered for employment, it will be necessary for me to
reapply and fill out a new application.
THE HOG reserves the right to terminate my employment at any time, with or without cause, THE HOG shall be
entitled to terminate my participation in THE HOG’s events at any time. This application does not constitute an
agreement or contract for employment for any specified period or definite duration. I understand that no supervisor
or representative of THE HOG or Time Warner Cable is authorized to make any assurances to the contrary and that
no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing
and signed by THE HOG’s General Manager.
I understand if I am hired, I will be required to sign an employment contract with THE HOG. I also understand that if
I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that
federal immigration laws require me to complete an I-9 Form in this regard.
I have read and fully understand the 2015 THE HOG Rock Girl Official Rules. I understand that any information
provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i)
eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from THE
HOG’s services, whenever it is discovered.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT
STATEMENT.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant
Statement.
______________________________________________
Signature of Applicant
, 2015
Date
SPONSOR:
102.9 The HOG (WHQG-FM/Lakefront Communications, LLC)
5407 W McKinley Ave. Milwaukee, WI 53208