Full Name - Keystone Staffing



666751016012747 Olive Blvd., Suite 200, Creve Coeur, MO 63141P 314.878.7200 F 314.878.1566331 Salem Place, Suite 180, Fairview Heights, IL 62208P 618.632.7600 F 618.632.7610Equal Employment Opportunity (EEO) Employer StatementKeystone Partnership provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Keystone Partnership complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.Keystone Partnership expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Keystone Partnership’s employees to perform their job duties may result in discipline up to and including discharge.0012747 Olive Blvd., Suite 200, Creve Coeur, MO 63141P 314.878.7200 F 314.878.1566331 Salem Place, Suite 180, Fairview Heights, IL 62208P 618.632.7600 F 618.632.7610Equal Employment Opportunity (EEO) Employer StatementKeystone Partnership provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Keystone Partnership complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.Keystone Partnership expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Keystone Partnership’s employees to perform their job duties may result in discipline up to and including discharge.Full Name FORMTEXT ?????Street Address FORMTEXT ?????City, State, Zip Code FORMTEXT ?????Primary Phone FORMTEXT ?????Secondary Phone FORMTEXT ?????Email Address FORMTEXT ?????EducationEducationInstitutionHighest Level CompletedDiploma/DegreeHigh School FORMTEXT ????? FORMCHECKBOX 9 FORMCHECKBOX 10 FORMCHECKBOX 11 FORMCHECKBOX 12 FORMTEXT ?????College FORMTEXT ????? FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 4 FORMTEXT ?????Trade/Technical School FORMTEXT ?????Length of program FORMTEXT ????? FORMTEXT ?????AvailabilityAvailable DateTime PreferenceMinimum Desired Salary FORMTEXT ????? FORMCHECKBOX Full FORMCHECKBOX Part$ FORMTEXT ????? / FORMCHECKBOX hour FORMCHECKBOX yearShort Term TemporaryLong Term TemporaryContract to Hire FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX NoContract ExperienceIn the past year, have you accepted contract work from another agency? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, where were you placed? FORMTEXT ?????Additional InformationAre you authorized to work in the U.S.? FORMCHECKBOX Yes FORMCHECKBOX NoAre you 18 years of age or older? FORMCHECKBOX Yes FORMCHECKBOX NoHave you ever worked for Keystone? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, where and when: FORMTEXT ?????How did you hear about Keystone? FORMTEXT ?????Previous or Current EmploymentCompany Name FORMTEXT ?????Start Date FORMTEXT ?????End Date FORMTEXT ?????Address, City, State, Zip FORMTEXT ?????Title/Role FORMTEXT ?????Reason For Leaving FORMTEXT ?????Supervisor Name FORMTEXT ?????Supervisor Phone FORMTEXT ?????Salary FORMTEXT ?????May we contact Supervisor? FORMCHECKBOX Yes FORMCHECKBOX NoPrevious Employment HistoryCompany Name FORMTEXT ?????Start Date FORMTEXT ?????End Date FORMTEXT ?????Address, City, State, Zip FORMTEXT ?????Title/Role FORMTEXT ?????Reason For Leaving FORMTEXT ?????Supervisor Name FORMTEXT ?????Supervisor Phone FORMTEXT ?????Salary FORMTEXT ?????May we contact Supervisor? FORMCHECKBOX Yes FORMCHECKBOX NoPrevious Employment HistoryCompany Name FORMTEXT ?????Start Date FORMTEXT ?????End Date FORMTEXT ?????Address, City, State, Zip FORMTEXT ?????Title/Role FORMTEXT ?????Reason For Leaving FORMTEXT ?????Supervisor Name FORMTEXT ?????Supervisor Phone FORMTEXT ?????Salary FORMTEXT ?????May we contact Supervisor? FORMCHECKBOX Yes FORMCHECKBOX NoPrevious Employment HistoryCompany Name FORMTEXT ?????Start Date FORMTEXT ?????End Date FORMTEXT ?????Address, City, State, Zip FORMTEXT ?????Title/Role FORMTEXT ?????Reason For Leaving FORMTEXT ?????Supervisor Name FORMTEXT ?????Supervisor Phone FORMTEXT ?????Salary FORMTEXT ?????May we contact Supervisor? FORMCHECKBOX Yes FORMCHECKBOX NoPrevious Industry Experience FORMCHECKBOX Advertising (EAA) FORMCHECKBOX Automotive (EAB) FORMCHECKBOX Architecture (EAC) FORMCHECKBOX Aerospace (EAD) FORMCHECKBOX Banking (EAE) FORMCHECKBOX Bio/Chemistry (BIO) FORMCHECKBOX Communication (EBE) FORMCHECKBOX Construction (EAF) FORMCHECKBOX Credit Union (EAG) FORMCHECKBOX Distribution (EAH) FORMCHECKBOX Engineering (EAI) FORMCHECKBOX Entertainment (EAJ) FORMCHECKBOX Electronics (EAK) FORMCHECKBOX Food (EAM) FORMCHECKBOX Finance (EAN) FORMCHECKBOX Government (EAO) FORMCHECKBOX Healthcare (EAU) FORMCHECKBOX Mortgage (MOR) FORMCHECKBOX Insurance (EAR) FORMCHECKBOX Legal (EAS) FORMCHECKBOX Management (MGT) FORMCHECKBOX Marketing (EAT) FORMCHECKBOX Manufacturing (EAV) FORMCHECKBOX Merchandising (MER) FORMCHECKBOX Non-Profit (EAW) FORMCHECKBOX Public Accounting (EAX) FORMCHECKBOX Public Utilities (EAY) FORMCHECKBOX Purchasing (PUR) FORMCHECKBOX Property Mgmt. (EBA) FORMCHECKBOX Real Estate (EBB) FORMCHECKBOX Retail (EBC) FORMCHECKBOX Transportation (EBF)Relevant Experience/Skills FORMCHECKBOX iOS/Mac Platform (AAE) FORMCHECKBOX PeopleSoft (PEA) FORMCHECKBOX Ceridian (CER) FORMCHECKBOX SAP (PAS) FORMCHECKBOX ADP (ADP) FORMCHECKBOX MS Word (ABM) FORMCHECKBOX MS Excel (ACA) FORMCHECKBOX MS Publisher (AFA) FORMCHECKBOX MS PowerPoint (ADG) FORMCHECKBOX MS Access (AEA) FORMCHECKBOX MS Dynamics (MSD) FORMCHECKBOX MS Outlook (MSO) FORMCHECKBOX SharePoint (SHA) FORMCHECKBOX Corel Draw (AFD) FORMCHECKBOX AS400 (ASF) FORMCHECKBOX Adobe Suite (AFG) FORMCHECKBOX Oracle (ORA) FORMCHECKBOX Peachtree (AGA) FORMCHECKBOX Great Plains (GRP) FORMCHECKBOX QuickBooks (QBA) FORMCHECKBOX JD Edwards (JDE) FORMCHECKBOX Customer Service (BAA) FORMCHECKBOX File Clerk (BAC) FORMCHECKBOX Telemarketing (TEL) FORMCHECKBOX Mail Room (BAD) FORMCHECKBOX Data Entry, 10 Key (BAK) FORMCHECKBOX Data Entry, Alphanumeric (DEA) FORMCHECKBOX Call Center (CEN) FORMCHECKBOX Dictaphone (BBA) FORMCHECKBOX Corporate Travel (COR) FORMCHECKBOX Administrative Assistant (BBD) FORMCHECKBOX Executive Assistant (BBE) FORMCHECKBOX Paralegal (BBH) FORMCHECKBOX Insurance Claims (BEA) FORMCHECKBOX Health Insurance (BEB) FORMCHECKBOX Insurance Underwriter (BED) FORMCHECKBOX Insurance Verification (BEE) FORMCHECKBOX Certified Public Accountant (CAA) FORMCHECKBOX Accounts Payable (CAB) FORMCHECKBOX Accounts Receivable (CAC) FORMCHECKBOX Collections (CAD) FORMCHECKBOX General Ledgers (CAE) FORMCHECKBOX Payroll (CAG) FORMCHECKBOX Tax Accounting (CAH) FORMCHECKBOX Telecommunication (TCM) FORMCHECKBOX Office Management (OFF) FORMCHECKBOX Spanish Fluency (YDA) FORMCHECKBOX Reception, 1-10 Lines (BCC) FORMCHECKBOX Medical Filing (BAJ) FORMCHECKBOX Medical Billing (MBI) FORMCHECKBOX Medical Coding (MBA) FORMCHECKBOX Janitor/Maintenance (DAJ) FORMCHECKBOX Inventory (DAL) FORMCHECKBOX Quality Control (DAV) FORMCHECKBOX HR Admin/Coordinator (EAP) FORMCHECKBOX Recruiting (HRD)BACKGROUND INVESTIGATION AND DRUG SCREEN CONSENTDrug ScreenI hereby give my consent and express my willingness to undergo a drug test as requested by Keystone Staffing Resources. I also consent to the release of the results of the test to Keystone Staffing Resources. I am also consenting to the collection of a urine sample from me by my employer’s physician or testing representative, which is sent to a laboratory selected by my employer. I understand that this laboratory conducts screening tests on this urine sample to detect the presence of illegal narcotics, including marijuana and other drugs, as well as signs of abuse of legal drugs. I understand that all samples are subject to careful testing procedures with mandatory confirmation of any preliminary positive results. I understand that a positive result on a drug test can result in revocation of my employment with Keystone Staffing Resources. I agree to release and discharge Keystone Staffing Resources and any of its designated medical personnel, agents, or authorized testing laboratories from any claims or potential liability arising out of or related to any physical or medical examination or the results of such examinations or tests that I have been asked to undergo by Keystone Staffing Resources.Background CheckI authorize Keystone Staffing Resources to conduct a background check that will include a criminal background investigation, and also verification of my job qualifications, employment history, academic credentials, licenses, professional designations, and driving record. I understand that employment is contingent upon a satisfactory background check. In addition, misrepresentations and/or omission of any facts on the Employment Application and/or resume are sufficient cause for summary dismissal when it is discovered. In exchange for Keystone Staffing Resources’ consideration of my employment application, I agree not to file or pursue any complaints, claims, or legal actions of any kind against any organization or individual that provides work-related information about me to Keystone Staffing Resources or its agents in accordance with the terms and intent of this release. I also agree not to file or pursue any complaints, claims, or legal actions against Keystone Staffing Resources or any of its employees, representatives, affiliates, or agents arising out of their efforts to obtain work-related information about me.“Please note it is the intention of the company to comply with state and federal laws. Where state and federal law differ, however, the company will typically comply with federal law.? The company also may be required to comply with federal law for employees in federally regulated positions.? For example, some state laws permit the use and possession of marijuana for medical and/or non-medical purposes. Federal law does not.? In the absence of state law to the contrary, the company considers marijuana to be an illegal drug for purposes of this policy in all locations – even those that allow for medical and/or non-medical use.”Full Name: FORMTEXT ?????Maiden Name/Alias: FORMTEXT ?????Social Security Number: FORMTEXT ?????Date of Birth: (Month/Day) Current Address: FORMTEXT ?????Length of Residence: FORMTEXT ?????Previous Address: FORMTEXT ?????Length of Residence: FORMTEXT ?????Signature and Date:Equal Employment Opportunity EmployerKeystone Staffing Resources provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Keystone Staffing Resources complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.Keystone Staffing Resources expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Keystone Staffing Resources’ employees to perform their job duties may result in discipline up to and including discharge.AcknowledgmentI verify that all of the information provided by me on this application is true, correct and complete. I understand that false or misleading statements or the omission of any information necessary to make this application complete may result in rejection of my application, or dismissal if hired by Keystone Staffing Resources. I understand that any employment relationship with Keystone Staffing Resources is of an ‘at will’ nature, which means that the employee may resign at any time and the employer may discharge employee at any time with or without cause. I understand this ‘at will’ employment relationship may not be changed verbally or by any written document unless such change is specifically acknowledged in writing by an authorized officer of Keystone Staffing Resources. I also understand that nothing contained in this application, or in the granting of an interview, created a contract or offer of employment between Keystone Staffing Resources and me for either employment or for the providing of benefits. I further understand that should I be offered employment, my employment is subject to successful completion of an employment background, credit check, Motor Vehicle Report, criminal and employment reference check. If I am hired, I agree to abide by all policies and procedures of Keystone Staffing Resources. I hereby authorize Keystone Staffing Resources to investigate all facts contained in my application for employment with said company, and authorize the release of any and all information by my present and past employers, wherever located, which may be required for a reference check. I further authorize all of my previous employers and current employer to give any and all information concerning my employment and any other pertinent information which said employers may have, personal or otherwise, and I release all parties from all liabilities for any damages which may result from the furnishing of said information. A copy of this release shall be as valid as the original. 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