COMMONWEALTH BROADCASTING GROUP, INC.
APPLICATION FOR EMPLOYMENT
                   
An Equal Opportunity Employer
We do not discriminate on the basis of race, color, race, religion, national origin, sex, age, or disability. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.
Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered. Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on back of application. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.
                     
Job applied for              Today's Date      
                     
What type of employment?   Full-time   Part-time   Temporary    
                     
Do you have the ability to perform the essential functions of this position?      
                     
Salary desired $       per          
                     
When could you start work?                
                     
Where did you learn of this position?                
                     
                   
                     
                     
Last Name   First Name   Middle Name
                     
                     
Present Street Address City State Zip Code
                     
Home Phone (           )         Bus. Phone (           )    
                     
Are you 18 years of age or older?   Yes   No        
    (If you are hired, you may be required to submit proof of age.)
                     
If hired, can you furnish proof you are eligible to work in the U.S.?   Yes   No
                     
                   
                     
Have you ever applied here before?   Yes   No        
  If yes, when?                
                     
Have you ever been convicted of any law violation?   Yes   No    
  If yes, give details                
  What was the offense?              
  Date of conviction and sentence?            
  (A "yes" answer does not automatically disqualify you from employment, since the nature of the offense, date, and the job for which you are applying will be considered.)
                     
Are you willing to relocate?   Yes   No        
                     
Are you willing to travel?     Yes   No   % of time    
                     
Are you now or do you expect to be engaged in any other business or employment?    
                     
        Yes   No        
  If yes, explain                
                     
                     
COMMONWEALTH BROADCASTING GROUP, INC.
APPLICATION FOR EMPLOYMENT
                 
                 
Education: List Name & Address of Schools        
                 
High School or GED              
                 
                 
                 
                 
    Graduate    Yes   No    
                 
College                 
                 
                 
                 
                 
    Graduate    Yes   No    
                 
Subjects Studied              
                 
                 
                 
                 
Vocattional or Technical              
                 
                 
                 
                 
Subjects Studied              
                 
                 
                 
                 
                 
               
                 
                 
COMMONWEALTH BROADCASTING GROUP, INC.
APPLICATION FOR EMPLOYMENT
                 
                 
Special Skills              
                 
What skills or additional training do you have that are related to the job for which you are applying?
                 
                 
                 
Computer experience?     Yes   No Yrs.  
                 
Software  (list software you are experienced in)        
                 
                 
                 
Are you bilingual?     Yes   No    
  If yes, specify languages            
                 
If your position requires that you drive, do you have a valid driver's license?  
                 
        Yes   No    
  Driver's License Number            
  State Licensed in            
  Have you had your license been suspended or revoked in the last 3 years?
                 
        Yes   No    
       If yes, give details            
                 
List professional, trade, business, or civic activities and offices held.    
(Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability, or other protected status.)
                 
                 
                 
List any governmental or professional licenses or accredication held:    
                 
                 
                 
                 

 

COMMONWEALTH BROADCASTING GROUP, INC.
APPLICATION FOR EMPLOYMENT
                   
                   
Work History                  
List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any period of unemployment. If self-employed, give firm name and supply business references.
                   
  From         To      
    MONTH   YEAR     MONTH   YEAR
                   
Name of Employer           Title      
Supervisor                  
Address           Pay      
City, State, ZIP             START   FINAL
Telephone                  
                   
Duties                  
                   
                   
                   
  From         To      
    MONTH   YEAR     MONTH   YEAR
                   
Name of Employer           Title      
Supervisor                  
Address           Pay      
City, State, ZIP             START   FINAL
Telephone                  
                   
Duties                  
                   
                   
                   
  From         To      
    MONTH   YEAR     MONTH   YEAR
                   
Name of Employer           Title      
Supervisor                  
Address           Pay      
City, State, ZIP             START   FINAL
Telephone                  
                   
Duties                  
                   
                   
   
COMMONWEALTH BROADCASTING GROUP, INC.  
APPLICATION FOR EMPLOYMENT  
                     
                     
References                  
                     
Have you worked or attended school under any other name?     Yes   No
  If yes, give names                
                     
Are you presently employed?           Yes   No
  If yes, may we contact your employer?            
                     
Have you ever been fired from a job or asked to resign?     Yes   No
  If yes, please explain              
                     
Give 3 references (no relatives or former employers)          
                     
Name   Address     Occupation   Phone Yrs. Known
                     
                     
                     
                     
                   
                     
Affidavit                  
PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING
                     
I certify that all information provided in the employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.
                     
I understand that this application will remain active for 45 days only. If I am not selected for this position, I must reapply for future openings. I understand that the employer may request an investigative consumer report from a consumer reporting agency. This report may include information as to my character, reputation, personal characteristics, and mode of living obtained from interviews with neighbors, friends, former employers, schools, and others. I understand I have a right to make a written request within a reasonable time for the disclosure of the nature and scope of the investigation.
                     
I authorize the investigation of any or all statements contained in this application and also authorize a person, school, current employer (except as previously noted), past employers, and organizations named in this application to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.
                     
I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre and/or post employment drug screen as a condition of employment, if required.
                     
I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WiTHOUT NOTICE.
                     
I have read, understand, and by my signature consent to these statements.
Signature           Date