Employment Application

This 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

Are you 18 or older?

City

Yes

State

Zip code

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 ________

Grad School _________________________________________________________________Graduated?

Y N Degrees ________

Name

Name

City

City

State

State

List 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 falsification of this information is grounds for rejection of my application and immediate dismissal if discovered post-hire. I authorize the Company 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.