Way of Lights Application Please fill out the application below to apply to work the 2014 season at Shrine! Last Name     First Name Initial Today’s Date Home Phone: Street Address Apt #       Cell Phone: City State ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming     ZIP Work Phone: e-mail address Emergency Contact Name       Phone #:       EDUCATION Education School Attended Highest Level Completed Diploma / Degree High School      ---9101112       ---YesNoGED College      ---1234      ---AssociatesBachelorsMastersPhDOther 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: ---YesNo                $ 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.