SUSQUEHANNA COMMUNICATIONS

SUSQUEHANNA PFALTZGRAFF
EMPLOYMENT APPLICATION

The Pfaltzgraff Co.
Susquehanna Radio Corp.

Susquehanna Media Co.
Suscom

* Indicates field is required.
* Position(s) Applied for:
* SusCom Location of Position(s) Applied for:
full time	part time
Salary Desired
Shift Preferred
Date Available for Work
Social Security Number and signature will be required at the time of your interview
* Last Name
* First Name
Middle Name
* Telephone No. (please include area code)
Email Address
Present Address
* Street Number
* City
* State
Zip

If hired, can you furnish proof that you are eligible to work in the US?	Yes	No
If you are under the age of 18 can you provide required proof of eligibility to work?	Yes	No
Are you willing to relocate to our service area if necessary?	Yes	No
Were you previously employed by Susquehanna Pfaltzgraff Co. or any of its subsidiary or affiliated companies? If yes, when?	Yes	No

Do you have any relatives that work for this company? If yes, please provide
the following information.

Yes

Name	Occupation
Name	Occupation

Are You Currently Employed?	Yes	No
May we contact your present employer?	Yes	No
Are you currently on "layoff" status and subject to recall?	Yes	No
Are you a High School Graduate or hold a G.E.D.?	Yes	No
If No, what was your last grade Completed?

School

Name & Address of School

Course of Study

Last Year Completed

List Diploma or Degree
or Rank at Discharge

Year Received

Business or Trade

College

Post graduate

Other

Military

Are you attending any school now?

Yes

If yes where? Course Titles

Class Hours Days of week

Expected date of completion:

month

day

year

Please list any additional schooling, training, job experience or skills which you feel would qualify you for a position with this company.