General

* First Name:
* Middle Initial:
* Last Name:
Address:
Address 2:
City:
State:
Zip:
Phone Number:
Email:
Other Names Used:
* Are You Authorized to work in the United States?:Yes No
* Are you at least 18 years of age?: Yes No
If Not, do you have a work permit:
Yes No
* How were you referred to Boys & Girls Club?:
* Previous Employment with the Boys & Girls Club
(If any, give dates, position, location)
* Relatives Employed by BGCA?:
* * Have you been convicted of, plead guilty to, and/or pled Nolo Contendre to a crime (Felony OR Misdemeanor, including but not limited to sexual offender crimes, theft, banking fraud, drug and/or alcohol-related offenses, assault, etc.)?
Yes No
If yes, please explain:

(Note: Conviction of a crime will not necessarily disqualify you for employment.
Each conviction will be judged on its own merit with respect to time and job relatedness.)


Position Applied For

* Title or Category:
* Salary Requirements:
* Date Available: (mm/dd/yyyy)
* Willingness to Travel:
(Approximate percentage if position indicates)


Job Description

Can you perform this job (as detailed verbally in the job description) with or without reasonable accommodation?


Education

High School

Graduated?: Yes No
Name and Location:

College or University

Graduated?:YesNo
Name and Location:
Major
Degree:

Other Schools

Graduated?:Yes No
Name and Location:
Major:
Degree:

Other Skills

Other Skills or Training:

Military Service

Did you serve in
the Military?:
YesNo
U.S. Military Branch
Highest Rank Achieved:
Date of Enlistment:
Date of Separation or Discharge:

All Applicants

Typing Speed:
Office machines
you can operate:
Software application skills:
Hours of Availability:
Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday


Work Experience

Current or Last Employer

Company Name:
Your Title:
Address:
Address 2:
City:
State:
Zip:
Start Date:
End Date:
Starting Salary:
Last Salary:
Supervisor's Name:
Supervisor's Title:
Phone Number:
May we contact employer?:Yes No
Brief Description of duties and responsibilities:
Reason for Leaving:

Previous Employer

Company Name:
Your Title:
Address:
Address2:
City:
State:
Zip:
Start Date:
End Date
Starting Salary:
Last Salary:
Supervisor's Name:
Supervisor's Title:
Phone Number:
May we contact employer?: Yes No
Brief Description of
duties and responsibilities:
Reason for Leaving:

Previous Employer

Company Name:
Your Title:
Address:
Address2:
City:
State:
Zip:
Start Date:
End Date:
Starting Salary:
Last Salary:
Supervisor's Name:
Supervisor's Title:
Phone Number:
May we contact employer?:Yes No
Brief Description of
duties and responsibilities:
Reason for Leaving:

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Application Signature

* Have read and agree with the application Authorization to Release employment reference information.
* Have read and agree with the Job Applicant Agreement.
Signature:
Signature Date:
By entering your full name and date into the fields above,
you are signing the Membership application