Regional Services Corporation
249 W. Third Street
Lewistown, Pa 17044

Which Corporation are you applying for:

Position Applied for:

Phone Number

Eligible for work in this country?

Yes

How did you learn about this opening?

Do you have a valid PA driver's license?

Yes

Are you over the age of 18?

Yes

Have you ever been refused a bond?

Yes

Have you ever been convicted of a felony?

Yes

If yes, please describe conditions

Education

High School Attended

Degree Received

College Attended

Degree Received

Other Education

List professional organizations of which you are member and professional licenses you hold which are relevant to the position you are applying

List office machines you can operate

Copier

Fax

Typing WPM/ Dictation WPM

Why do you think you are a good candidate for this position?

Other Comments?

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