Chesterfield Valley Pumpkin Patch Last Name First Name Middle Name Street Address Apartment/Unit # City State Zip Code ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming 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 ---9101112 ---YesNoGED College ---1234 ---AssociatesBachelorsMastersPhDOther Trade School / Technical Training Length ---YesNo 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: ---Morning (5am-10am start time)Day (10am-4pm start time)Both $ 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? ---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: 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.
