Hollywood Casino Amp App - Keystone Event Staffing

Last Name First Name Initial						Today’s Date
				Home Phone:
Street Address Apt #
				Cell Phone:
City State ZIP
				Work Phone:
e-mail address				Emergency Contact Name Phone #:
EDUCATION
Education			School Attended		Highest Level Completed	Diploma / Degree
High School
College
Trade School / Technical Training					Program Length	Certificate
AVAILABILITY
When can you begin working?		Are you available for Day shifts?	When do you return to school? (College Students Only)	Do you have any upcoming conflicts? (ie vacations, camps, etc)		Least Acceptable hourly rate:
						$/hour
WORK EXPERIENCE
1	Dates Employed	Employer		Job Title	Salary/Wage	Reason for Leaving

2	Dates Employed	Employer		Job Title	Salary/Wage	Reason for Leaving

3	Dates Employed	Employer		Job Title	Salary/Wage	Reason for Leaving
REFFERAL SOURCE			ADDITIONAL QUESTIONS
Keystone Website: Yes Flyer: Yes Local Paper: Yes From a Friend: School: Internet: Other:			Have you ever been convicted of a felony? YesNo Are you 18 years of age or older?YesNo 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? YesNo Do you require any special accommodations in order to perform your work? YesNo If yes, please explain:

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, pre 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.