Keystone Human Services  
Keystone Human Services International:
Application for International Training Program

Keystone Human Services is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, gender, marital status, national origin, disability or handicap, or veteran status.

Note: This application must be fully completed.

Date of Application
   
Personal  

Family Name

Given Name

Middle Initial

Street or PO Address

City

Region or Province
(if applicable)
State
ZIP

Country

Home Telephone

Other Telephone

Best Time to Call
E-mail

Date of Birth
(mm/dd/yyyy)

Country of Birth
Country Where Passport was Issued
Expiration Date
(mm/dd/yyyy)
   

Do you possess a valid driver’s license for the country in which you reside?  
Yes      No
   
Do you possess a valid international driver’s license?  
Yes      No
   
If yes, please list License number
Expiration Date
(mm/dd/yyy)
   
Have you ever applied for a U.S. visa?    Yes      No

If so, when was the application made?
(mm/dd/yyy)
What kind of visa did you apply for?
What was the result of that application?
   

Please indicate your knowledge of English:

Oral     Written  
Fluent
   Fluent
Good   Good
Satisfactory   Satisfactory
Basic   Basic

 

Education  
School Name
School Address
Major Course of Study
Years Attended
   
College Name
(Undergraduate)
School Address
Major Course of Study
Years Attended
   
College Name
(Postgraduate )
School Address
Major Course of Study
Years Attended
   
   
Practical Training  
Please answer the following in their entirety:
1. What kind of experience do you have (including volunteering)?
   
2. How will training at Keystone be of benefit to you in the future?
   
3. What kind of job duties do you expect from your Training?
   
4. Possible start day and duration of stay.
   

 

  

Applicant's Certification and Agreement

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Keystone Human Services to verify their accuracy and to obtain reference information on my work performance. I hereby release Keystone from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.

I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal.

I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of Keystone. However, I further understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.
 
Please type your initials in the box below to show that you accept the terms of this agreement. If you do not agree, your application will not be processed for consideration.
Your initials  
 

When you have completed the entire form, please click on the Submit Application button below. Your request will be forwarded to the Practical Training Selection Committee, and processed as soon as possible.
   

Return to International Practical Training Program
 
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