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Consider joining our team of dedicated staff helping people with developmental disabilities lead fulfilling lives!

 

View available positions

Application for Employment

Please complete the entire application. You can submit a separate cover letter and resume via email to our recruitment department to provide us with additional information.

Keystone Community Resources, Inc. is an equal opportunity employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, sexual orientation, citizenship status, marital or veteran status, or the presence of a non-job-related medical condition or disability.

Position(s) Applied For
How did you hear about us?	Please Select Keystone Job Fair Public Job Fair Keystone Employee Keystone Poster Keystone Website Placemats Radio Scranton Times TV Commercial Word of mouth Other
Specify other
Date of Application	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2010 Please select an item.
First Name
Middle Initial
Last Name
Address
City
State
Zip
Home Telephone
Other Telephone
E-Mail

 

 

 

 

 

 

 

 

 

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Are you at least 21 years of age?	Yes No
If not, birth date	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1987 1988 1989 1990 1991 1992
Have you ever applied for work here before?	Yes No
Have you ever been employed here before?	Yes No
If Yes, give date	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Are you prevented from lawfully becoming employed in this country because of Visa or immigration status?	Yes No
On what date would you be available for work?	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008
Are you available to work	Yes No Full time Yes No Part Time
	Yes No Shift Work Yes No Temporary
Are you on a lay-off and subject to recall?	Yes No
Can you travel if the job requires it?	Yes No
Will you work overtime if needed?	Yes No
Have you ever been convicted of a crime?	Yes No
If yes, please explain

 

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Education
High School/GED
School Name
Years completed	9 10 11 12
Graduate/GED?	Yes No
College/University
School Name
Years completed	1 2 3 4
Degree
Year Graduated
Graduate/Professional
School Name
Years completed	1 2 3 4
Degree
Year Graduated

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Employment Experience
Start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which include race, color, religion, sex, marital status, age, disability, sexual orientation or citizenship status.
Employer 1
Name of Employer
Address
Phone Number
Job Title
Supervisor
Dates Employed	From To
Hourly Rate/Salary	Start Final
Work Performed
Reason for Leaving
Employer 2
Name of Employer
Address
Phone Number
Job Title
Supervisor
Dates Employed	From To
Hourly Rate/Salary	Start Final
Work Performed
Reason for Leaving
Employer 3
Name of Employer
Address
Phone Number
Job Title
Supervisor
Dates Employed	From To
Hourly Rate/Salary	Start Final
Work Performed
Reason for Leaving

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Special Skills and Qualifications
Summarize special skills and qualifications acquired from employment or other experience
Give name, address and phone number of three references who are not related to you and are not previous employers

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Applicant Data Record
Submission of this section is voluntary
Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital status, medical condition, disability, sexual orientation or citizenship status. As employers/government contractors, we comply with government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the Applicant Data Record. We appreciate your cooperation. This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment.
Check one	Male Female
Check one of the following	White African American Hispanic
	American Indian/Alaskan Native
	Asian/Pacific Islander
Check if any of the following are applicable	Vietnam Era Veteran Disabled Veteran
	Handicapped Individual

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Applicant's Statement
I certify that answers give herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, including, but not limited to, prior work and education record, criminal history, etc. I further authorize any past or present employer, and law enforcement agency, and physician or hospital or any school, and any and all of their employees from any liability in furnishing such information to Keystone Community Resources, Inc. or its affiliates. I understand that this application is not and is not intended to be a contract of employment, expressed or implied, and if hired, my employment may be terminated at any time without reason. I agree to provide a urine specimen voluntarily to the laboratory selected by Keystone Community Resources, Inc. or its affiliates with the understanding that it will be tested for common drugs of abuse. This testing is consistent with the desire of Keystone Community Resources, Inc. to provide a safe, efficient work place and to encourage the health and well-being of its employees. I understand that the results of my urine tests will remain confidential and will be used only for the purpose of determining the suitability of my employment with Keystone Community Resources, Inc. I understand that determining suitability is within the total discretion of Keystone Community Resources, Inc. and that a positive result of my urine test will result in a rejection of my application for employment. In consideration of my application for employment with Keystone Community Resources, Inc. I hereby release Keystone Community Resources, Inc.and its affiliates, its administration, and/or employees from any claim or action or potential claim or action arising out of the urine testings, including those relating to the right to privacy or the rejection of my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all the rules and regulations and policies of Keystone Community Resources, Inc. and will be required to take a physical examination to include a mantoux T. B. test, prior to employment, along with criminal history check and child abuse history clearance check as required by Pennsylvania State Regulations.
Please initial here	A value is required.

 

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Keystone Community Resources, Inc. • 100 Abington Executive Park, Clarks Summit, PA 18411 • Phone: 570-702-8000 Fax: 570-702-8093

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