Employment ApplicationThis application for employment will be kept on file for one (1) year. Any applicant wishing to be considered for

employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

PERSONAL INFORMATION

Date ____________________________________________ Social Security Number _______________________________________

Name: _______________________________________________________________________ Home phone____________________ Last First M.I.Mobile phone ________________________________________ email address ____________________________________________

How do you prefer to be contacted? 5 U.S. mail 5 email 5 mobile phone 5 home phone 5 other___________________________

Address: ____________________________________________________________________________________________________ Street City State Zip codeAre you 18 or older? Yes No If no, state your age ___________

Position desired ____________________________________________________________ Full time __________ Part time ________

Minimum salary desired _____________________________________________ Are you currently employed? __________

EDUCATION

High school _________________________________________________________________ _______ Graduated? Y N GED? Y N Name City State College _____________________________________________________________________Graduated? Y N Degrees ________ Name City StateGrad School _________________________________________________________________Graduated? Y N Degrees ________ Name City StateList special skills or training: _____________________________________________________________________________________

MILITARY SERVICE

Branch ______________________________________ Dates served: __________ to _________Current Reserve Status __________

EMPLOYMENT HISTORY (Please start with the most recent or current employer)

Company:____________________________________________________________________ From ___________ to ____________

Address: _______________________________________________________________________________Phone_______________

Position: ___________________________________________Name of supervisor ____________________Salary _______________

Reason for leaving: ________________________________________________If current, may we contact this employer? Yes No

Company:____________________________________________________________________ From ___________ to ____________

Address: _______________________________________________________________________________Phone_______________

Position: ___________________________________________Name of supervisor ____________________Salary _______________

Reason for leaving: ___________________________________________________________________________________________

Company:____________________________________________________________________ From ___________ to ____________

Address: _______________________________________________________________________________Phone_______________

Position: ___________________________________________Name of supervisor ____________________Salary _______________

Reason for leaving: ___________________________________________________________________________________________

GENERAL QUESTIONS

1. Is there a reason you may be unable to perform the essential functions of the job for which you are applying? 5 Yes 5 No

If yes, explain: _______________________________________________________________________________________________

2. Are you legally authorized to work in the United States? 5 Yes 5 No

3. Do you possess a valid New York State drivers license (if necessary for desired position)? 5 Yes 5 No

4. Have you ever been employed by a division of the Hearst Corporation before? 5 Yes 5 No

If yes, what unit and department ? ______________________________________________________From __________ to _________

5. Have you applied for employment with a division of the Hearst Corporation before? 5 Yes 5 No If so, when?_________________

6. State the names and relationships of any relatives you have who are employed here. ______________________________________

7. State the names of any friends you have who are employed here. _____________________________________________________

8. Have you ever been convicted of a felony? 5 Yes 5 No If yes, nature of conviction and date ________________________________________________________________________________________________________________________________________

9. Were you referred to the Times Union? 5 Yes 5 No If so, by whom? __________________________________________________

REFERENCES

Please list three (3) personal references (not former employers) ex: teachers, co-workers, acquaintances.

Name: ____________________________________________________________________________Phone: ____________________

Address: ____________________________________________________________________________________________________

How are you acquainted with this person? _____________________________________________ Time known __________________

Name: ____________________________________________________________________________Phone: ____________________

Address: ____________________________________________________________________________________________________

How are you acquainted with this person? _____________________________________________ Time known __________________

Name: ____________________________________________________________________________Phone: ____________________

Address: ____________________________________________________________________________________________________

How are you acquainted with this person? _____________________________________________ Time known __________________

READ CAREFULLY

I certify that the information contained in this application is true and correct to the best of my knowledge and understand that falsifi-cation of this information is grounds for rejection of my application and immediate dismissal if discovered post-hire. I authorize the Com-pany to investigate my record, including any information contained in this employment application, and also authorize the companies, schools or persons identified above to release information about me to the Company. I agree not to hold the Company or any persons or organizations liable with respect to any information that they solicit or provide. I understand that any offer of employment is contingent upon my presentation of the documents required by the Immigration Reform and Control Act of 1986, and successfully passing required background checks. I understand that my employment is at-will and can be terminated, with or without cause, and with or without notice, at any time at the option of either the Company or myself (unless otherwise stated in an applicable collective bargaining agreement, if any). I understand that nothing contained in this employment application, or in any oral representations made to me during the application process, creates an employment contract. I further understand that no Company representative, other than the Publisher, has the authority to enter into an agreement of employment for any specified period of time, or to make any agreement contrary to the foregoing.

__________________________________________________________ __________________________________________Signature Date

It is the policy of the Hearst Corporation to provide equal employment opportunity to all individuals without regard to race, color, religion, sex, national origin, age, disability or alienage. The Hearst Corporation will provide reasonable accommodations for otherwise qualified individuals with disabilities.