COMMUNITY ORGANIZATION NOTIFICATION REQUEST FORM

Please contact Station with any future changes in the general information below, 
especially the contact person and e-mail address.  It is important to keep your
information updated.  Thank you!

 Date _____________________

 I.  GENERAL INFORMATION (Please complete all sections.)  

 Name of Organization:                                                                                               

Address:                                                                                                                     

 City:                                                            State:                  Zip Code:                 

Telephone Number:                                          Fax Number:                                     

E-mail address:                                                                                               

Name of Contact Person/Title:                                                                                        

Type of Organization:                                                                                                     

II.  CATEGORIES OF JOB VACANCIES

Community organizations may request notice of all vacancies, or only those in specific categories.
Please indicate what category(s) of job vacancy notices you would like to receive.
(Please select your preferences.)

 ____ All Job Vacancies                                ____ Sales Workers 
____ Officials & Managers                               ____ Craft Workers (Skilled)
____ Professionals                                           ____ Operators (Semi-skilled) 

____ Technicians                                             ____ Laborers (Unskilled)
____ Office & Clerical                                    ____ Service Workers

PRIVACY NOTICE:  The Federal Communications Commission (FCC) requires all stations
to report the names of community organizations requesting job vacancy information plus
the contact person, address and telephone number of each organization in an annual
EEO Public File Report that will be made available to the general public in the station’s
public inspection file and on its website.

 By requesting to be notified of job vacancies, you consent to the public disclosure of this information as required by the FCC

Please return the completed form via e-mail, fax, or regular mail to: 
WLDE, 347 W. Berry St. Ste. 417, Fort Wayne, IN 46803, (260)423-3676,
fax: (260)422-5266.  Station WLDE is an Equal Opportunity Employer.

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For Internal Use Only:

Date Received by Station:                Name of Station Personnel Processing Info. :    

Mode of Delivery:   ___E-mail     ___U.S. Mail     ­­___Fax     ___Telephone     ___Other:         

Primary Notification Selected for Vacancies:                                               

Cancellation of Notice Date:                              Contact Person for Cancellation:                                               

Community Notification Request Form ~ Equal Employment Opportunity File Report
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