Important: Data Entry Home-Keyers are contractors doing work for Palm Coast Data; they are not employees of Palm Coast Data. Data Entry Home-Keyers must live in the city of Palm Coast.

First name Middle initial Last name

Address City Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Zip code

Email address

Phone voice line Phone data line

Who is your Internet Service Provider?

What operating system, and version, is installed on your PC?

What is the speed of your modem? 1440 33600 56000 do not know

How many words per minute can you type? 20-30 30-50 50-70 above 70

How many days are you available to work from home?

What hours can you work? 8am-5pm 5pm-10pm other

Can you work on the weekend? Yes No

Have you ever been convicted of a crime, other than a minor traffic violation? Yes No

Have you ever been employed by Palm Coast Data? Yes No

If you answered yes to the above question, under what name did you work?

Indicate how you would get the work to key would pick it up need it delivered

Do you have data entry experience? Yes No

If we contract with you, would you attend a training class in our office? Yes No