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