EmploymentApplication

*Inability to work certain times may, but will not necessarily, be a bar to employment.

Date Available

Prev Position

Loc/Dept Dates

Name

Present Address City/Town Zip

City/Town Zip Dates from Dates to

Name & Location Course of Study Graduate? Type of Degree

Perm Address City/Town

Cell Phone

Zip

Salary Requirements

Home Phone

Are you legally authorized to work in the U.S.?

Previous Addresses (include last 5 years)

Email

Must be verified at time of employment.

Evenings

Weekends

Overtime

1st Shift

2nd Shift

3rd Shift

Full Time

Part Time

Temporary

Summer

Co-op

Intern

Yes No

The Company may verify all educational information

Do you plan to continue your formal education? YesNo

Yes No

POSITION INFORMATION

PERSONAL INFORMATION

EDUCATION

Previous Employment with the Company (if applicable)

Availability*(check all that apply)

Type(check all that apply)

Last 4 digits of Social Security #

High School

Yes No

College

Yes No

Other

School

State

State

State

To be considered for employment by New Media Investment Group Inc.; and all of its direct and indirect subsidiaries, including, but not limited to GateHouse Media, LLC (the “Company”), applicants must complete an Employment Application. The Company may conduct background checks on applicants who are offered employment with the Company; offers of employment are contingent on the successful completion of a background check and any inaccuracies presented on the application may disqualify candidates from employment eligibility with the Company. The Company is an equal opportunity employer. Qualified applicants are considered for all positions without regard to race, color, religion, gender, gender identity or expression, national origin, disability, age, sexual orientation, veteran status, marital status, pregnancy, military status, alienage, citizenship, and other classes protected by federal, state, or local law. It is the policy of the Company to comply with all laws with regard to providing reasonable accommodation of disabilities to applicants and employees and not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the local, state, and federal law. For more information or to request an accommodation, please contact the Company. Information sought in this form will be used for permissible purposes only.

For verification purposes, please note any other last names that you used during that period of time. Do not indicate you have graduated until you have been awarded your degree or diploma. If you are completing your degree or it has not been awarded for any reason, you should answer “No” to the question of graduation.

Position

Company Name From Mo/Yr To Mo/Yr Work Performed

Number and Street Phone Supervisor

City and State Zip Reason for Leaving or Seeking to Leave

If you are employed, may we contact your present employer? Yes No May we contact your past employers? Yes No

Date Range Highest Rank

YesNo

U.S. Military experience

OTHER INFORMATION

Have you ever been convicted of a felony? Please read below before answering this question.

CALIFORNIA, CONNECTICUT, ILLINOIS, MASSACHUSETTS, MARYLAND, MINNESOTA, NEW YORK, OREGON, PENNSYLVANIA, RHODE ISLAND AND TEXAS APPLICANTS: Do not answer this question.

List periods of unemployment and explain.

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Company Name From Mo/Yr To Mo/Yr Work Performed

Number and Street Phone Supervisor

City and State Zip Reason for Leaving or Seeking to Leave

Company Name From Mo/Yr To Mo/Yr Work Performed

Number and Street Phone Supervisor

City and State Zip Reason for Leaving or Seeking to Leave

EMPLOYMENT INFORMATIONStarting with your present or most recent employment, list employment for the past 10 years, including self-employment, summer, part time, and part or full time military service. You may also include any work performed on a volunteer basis and attach resume. Ensure all dates are accurate and include month/year. Provide a reason for leaving all past positions. If you were employed through an employment agency, please note that company as your employer, as well as where you were assigned to work. You may also include any work performed on a volunteer basis and attach resume.

GEORGIA APPLICANTS: Do not disclose any discharge from Georgia’s First Offender Program.

OHIO APPLICANTS: You should answer “No Record” as to any convictions for marijuana possession involving an amount of less than 100 grams.

WISCONSIN - MADISON APPLICANTS ONLY: Respond to this inquiry only with respect to any convictions for which you were convicted, placed onprobation, paroled, released from incarceration or paid a fine, for a felony, misdemeanor or other offense, within the past three (3) years.

ALL APPLICANTS: You may answer “no” if a conviction has been sealed, expunged or impounded, annulled, statutorily eradicated or vacated, or that were diverted to a pre-trial or post-trial program that was successfully completed, or as to adjudications withheld, or any adjudications as a youthful offender.

SKILLS/ACHIEVEMENTS

Occupation Phone Years Known

Job Skills - Attach resume or list any skills or information you would like us to be aware of when considering your application.

Achievements - Attach resume or list any special licenses, certificates or registrations.

REFERRALS/REFERENCES

No Yes:

No

Yes: Were you interviewed?

Site Name and location?

Personal/Business References (non-relatives) Relationship

APPLICATION VERIFICATION/ACKNOWLEDGMENTNOTE: PLEASE READ BELOW. YOU MAY HAVE TO SIGN IN MORE THAN ONE PLACE.

FOR ARIZONA APPLICANTS: Pursuant to Ariz. Rev. Stat. § 36-601.01, the Company maintains a smoke-free workplace

FOR CALIFORNIA APPLICANTS: Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company, you are entitled to copies of any such public records obtained by the Company, unless you mark the check box at the end of this paragraph. If you are not hired as a result of such information, you are entitled to a copy of any such records even though you have checked this box

I, the applicant, waive receipt of a copy of any public record described in this paragraph

FOR MARYLAND APPLICANTS: I ACKNOWLEDGE THAT, UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

_____________________________________________________________________________________________

Signature Date

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Agency: Employee : Referred by Newspaper Internet

Do you know anyone employed by The Company?

Have you applied to The Company before? No

Yes:

To the extent permitted by applicable law, I hereby authorize the Company, its employees, representatives and agents to contact, obtain, and verify the accuracy of the information contained in this application from all educational references, employment references (unless otherwise indicated in the “Employment Information” section) and personal / business references (collectively, the “References”). I authorize the References to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. I also hereby release the Company from liability for seeking, gathering, and using such information to make employment decisions and all other persons or organizations, including but not limited to, the References, for providing such information. In addition, I here by authorize the Company to use outside agencies, to the extent permitted by applicable law, to verify the accuracy of information contained in this application.

I understand that any misrepresentation or material omission made by me on this application (or on any required documents) will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, regardless of when such misrepresentation or material omission is discovered.

If I am employed, I understand and acknowledge that my employment is voluntary and is subject to termination by either myself or the Company at will, with or without cause, and with or without notice, at anytime, to the extent not prohibited by applicable federal or state law. I also understand and acknowledge that nothing in this application shall be interpreted to be in conflict with or to eliminate or modify in any way the status of the Company’s at-will employees. I further understand and acknowledge that this application, and any prior or subsequent oral or written communication, is not intended to create an employment contract or agreement for employment.

If I am employed, I agree to comply with the Company’s policies and procedures and I acknowledge and understand that the Company reserves the right to amend its policies and procedures as it deems necessary.

I acknowledge that any offer of employment I receive may be withdrawn at anytime, and that I have not been promised that, if hired, my employment will continue for any set period of time. If I am employed, I understand and acknowledge that I will be required to provide satisfactory proof of identity and legal authorization to work by the later of: (a) three days from the date of hire; or (b) the time prescribed by applicable law. Failure to submit such proof within the required time shall result in immediate termination of employment.

I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I have read, understand, and will comply with all parts of it and have answered all questions completely and fully.

Applicant Signature _________________________________________________________________ Date ___________________________________

GH V1 EMPAPP 4_4_19

FOR MASSACHUSETTS APPLICANTS: I ACKNOWLEDGE THAT IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.

_____________________________________________________________________________________________

Signature Date

FOR RHODE ISLAND APPLICANTS: The Company is subject to Chapters 29-38 of Title 28 of the General Laws of Rhode Island and is therefore covered by the state’s worker’s compensation law.

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