Certification, authorization and release

I understand that to evaluate my candidacy for employment with Lake Broadcasting Inc., (“LBI Media”),will ask me for information about myself. I certify that all information that I provide to LBI Media, including in writing or in person, electronically, by hard copy or in any other format, is and will be true, correct and complete to the best of my knowledge, information and belief. I understand and agree that false information or significant omissions may disqualify me from further consideration for employment and, if I become employed, may result in my dismissal when discovered.

I authorize LBI Media to investigate all statements contained in this application (and any accompanying documentation) and to make inquiries of my personal, employment, financial and medical histories and other related matters as may assist LBI Media in arriving at a decision regarding employing me to the extent permitted by applicable laws.

In accordance with Department of Transportation Regulation 49 CFR Part 40, I authorize release of information from my Department of Transportation regulated drug and alcohol testing records by my previous employer. I understand that information to be released by my previous employer, is limited to the following DOT-regulated items: alcohol tests with a result of .004 or higher, verified positive drug tests, refusals to be tested, other violations of DOT agency drug and alcohol testing regulations, information obtained from previous employers of drug and alcohol rule violations and any documentation of completion of the return-to-duty process following a rule violation.

I hereby release from liability, to the fullest extent permitted by law, all individuals and organizations, including LBI Media, who/that provide and or procure information and/or reports in good faith regarding my background, competence, ethics, character and qualifications, including otherwise confidential information, in conjunction with my application for employment with LBI Media.

I understand that, if employed, I will be required to abide by all policies, rules and regulations of LBI Media, including rules regarding various health screens and immunizations as they may apply to my position at LBI Media. I understand, for example, that LBI Media employees who work in company buildings are required to receive an annual influenza vaccine unless granted a medical or religious exemption.