EEO Community Organization Notification Request Form

KTBB/KDOK/KEES/KYZS/KGLD EEO PROGRAM
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 by fax or regular mail to:
1001 ESE Loop 323 Suite 455,
Tyler, Texas 75701
Telephone: 903-593-2519
Fax: 903-597-4141.

Gleiser Communications LLC (KTBB/KDOK/KEES/KYZS/KGLD) is an Equal Opportunity Employer.