Application for Employment

Personal Information

Date: Social Security #:

Name
First: Middle: Last:

Present Address
Street: City: State: Zip Code:

Permanant Address
Street: City: State: Zip Code:
Home Phone#: Daytime Phone#:   

In case of emergency notify
Name: Phone#:
Address:

Education
School Name Where Located From To Years Degrees
Grammar
High School
College
Other


Employment Desired
Position: Salary Desired:  

Background
Have you ever been employed by Eagle Newspapers, Inc., or any of it's subsidiaries or divisions? Yes    No
Are you employed now? Yes    No
If so may we inquire of your present employer? Yes    No


Employment Record
    From
mo./yr.		 To
mo./yr.		 Duties Rate of Pay Reason for
Leaving
Present Employer Name
Address 		/ /
Last Employer Name
Address   		/ /
Next to Last Employer Name
Address 		/ /
One Other Employer Name
Address 		/ /
One Other Employer Name
Address 		/ /


Have you ever been convicted of a felony? Yes     No  
If yes, what was the offense?  
Date of conviction   Place of conviction  

U.S. Military Service
From   To   Branch   Rank  
Duties  
Present Military Status  
In making this application for employment it is understood that an investigative consumer report may be prepared whereby information concerning my character, general reputation, personal characteristics and mode of living may be obtained through personal interviews with my neighbors, friends or others with whom I am aquainted. Also an investigation may be requested to be made of my credit standing by a consumer reporting agency. I authorize both or either of such investigations to be made. I further understand that upon written request made within a reasonable period of time, I have the right to obtain additional detailed information about the nature and scope of these investigations, if made.

I authorize Eagle Newspapers, Inc. to investigate all statements contained in this application and hereby release former employers and Eagle Newspapers, Inc. from all liability on account of furnishing such information to Eagle Newspapers, Inc. It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellationof the application and/or for separation from the company's service if I have been employed. In the event of my employment by Eagle Newspapers,Inc. I agree to abide by all present and subsequently issued rules of Eagle Newspapers,Inc. I further understand and agree to a pre-employment drug screening test to be conducted by a laboratory selected by Eagle Newspapers,Inc. and at its expense. I understand that any offer of employment is conditional with reguard to negative results on the pre-employment drug screen.

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