Full Name: Street Address: City: State: = Select = Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D C Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Mass Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada N Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Have you ever applied for employment with us? yes     no     If yes, Month and Year               Position Desired: When are you available to start work? How did you hear about us? Income Requirement:

Date: How best to contact you? Please Choose Electronic Mail Regular Post Mail Home Telephone Work Telephone Fax Home Phone: Work Phone: Preferred Time to Call: Email Address:

A. HAVE YOU EVER BEEN DENIED A LICENSE, PERMIT OR PRIVILEDGE TO OPERATE A MOTOR VEHICHLE? YES     NO

B. HAS ANY LICENSE, PERMIT, OR PRIVILEDGE BEEN SUSPENDED OR REVOKED? YES     NO

C. HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES     NO

IF ANSWER TO A, B, OR C IS YES GIVE DETAILS HERE:

Previous Experience in Tower Industry

1	Company Name: Address:   (Please include city, state and zip.) Name of Supervisor: Job Title: Describe Your Work: Telephone: Employed from:      to:    Annual Income start:    last:    Reason for Leaving:
2	Company Name: Address:   (Please include city, state and zip.) Name of Supervisor: Job Title: Describe Your Work: Telephone: Employed from:      to:    Annual Income start:    last:    Reason for Leaving:
3	Company Name: Address:   (Please include city, state and zip.) Name of Supervisor: Job Title: Describe Your Work: Telephone: Employed from:      to:    Annual Income start:    last:    Reason for Leaving:

May we contact your current employer?
yes       no

Certifications and Training

Do You Have Any Certifications?

yes    no

Describe any training and certifications received related to the position for which you are applying.

Capital Tower will contact you within 48 hours to arrange an interview. I certify that the answers given herein are true and complete to the best of my knowledge. I also authorize Capital Tower and Communications Inc. to verify all statements contained in this application for employment and to obtain reference information on my work performance as may be necessary in arriving at an employment decision. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I,  , hereby attest that my employment and company driving status at Capital Tower & Communications Inc, Diversified Telecom Inc. or Capital General Contactors, Inc is contingent upon my ability to pass a physical with back evaluation prepared especially for each of these companies by Concentra Health Center. In addition, I will submit to a 5-panel drug screen as well as an on-site drug test by the company I am applying to. If I fail to pass any or all of these requirements for employment, I will be forfeit my chance for employment and be responsible for my own return transportation. Prospective Applicants Signature  (Type Your Full Name) (Your Electronic Signature Makes This Document Binding)

Please review all information carefully prior to submitting your application.