Chesterfield Valley Pumpkin Patch

Last Name

First Name

Middle Name


Street Address

Apartment/Unit #

 

 

City

State

Zip Code 

Today's Date

Home Phone:

Cell Phone:

Emergency Contact:

e-mail address

Emergency Phone:

EDUCATION

Education

School Attended

Highest Level Completed

Diploma / Degree

High School

College

Trade School / Technical Training

Length

AVAILABILITY

Are you available for morning and/or day shifts?

Do you have any planned vacations, camps etc?

Date you are available to start

Do you have time restrictions?

Desired Wage:

$

WORK EXPERIENCE

1

Dates Employed

Employer & Job Title

Reason for Leaving

Wage:

 

2

Dates Employed

Employer & Job Title

Reason for Leaving

Wage:

REFFERAL SOURCE

ADDITIONAL QUESTIONS


Keystoneeventstaffing.com
Refferal
Ad in paper
School/Flyer
Web Search
Other

Are you 18 years of age or older?

Some of our clients require drug testing as a condition for an assignment. Would you be willing to take a drug test as a condition for an assignment?

Do you require any special accommodations in order to perform your work? If yes:



EEO STATEMENT

Keystone provides equal employment opportunities to all employees and applicants for employment without regard to race, color, creed, religion, sex, age, national origin, citizenship, disability, veteran status or any other protected status.

This policy governs all areas of employment at Keystone, including recruiting, preĀ­ employment screening, hiring, training, assignments, promotions, compensation, benefits, discipline and terminations.


By clicking this box, I agree that all of the above statements and information are true and accurate.