Employment / Volunteer Application

Employment / Volunteer Application

GOLDSBORO 919-735-2358 I FREMONT 919-242-3276 I MOUNT OLIVE 919-658-9836
Welcome to the Boys & Girls Clubs of Wayne County Employment / Volunteer Application

We are excited that you are looking to join our team.

Before we begin we would like to confirm that you are a human. Yes, we all hate these captcha's. Since we pay for this service and are limited based on submissions we, have to take precautions to make sure you are not wasting our service.

This application can be completed via computer, tablet, or mobile device. We do recommend a tablet if you have one as it will be easier to do your digital signature via a tablet as needed.

Please note that all digital signature are legally binding and are as if you put pen to paper via this application. By continuing to fill in this application, you are accepting that your digital signature is as good as if you had put pen to paper.
Before you begin our application, please verify that you are human*

DATE*

MonthDayYear
Date
Club Location*
What location are you applying for?
EmploymentVolunteer

APPLICANT INSTRUCTIONS:
If you need help filling out this application form or any phase of the placement process, please notify the person that gave you this form and every reasonable effort will be made to accommodate your needs.
- Complete all pages as thoroughly as possible.
- If more space is needed, please attach the additional page(s).
- Print clearly; incomplete or illegible applications will not be reviewed or considered.
Please Initial saying you have read this section.*

APPLICANT NOTE:
This application form is intended for use in evaluating your qualifications for placement. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after placement, terminating placement. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to or after placement.
Please Initial saying you have read this section.*

EQUAL OPPORTUNITY EMPLOYMENT:
The Boys & Girls Clubs of Wayne County, Inc. will comply with and will fully endorse all the provisions of the Civil Rights Act of 1964 and all requirements imposed pursuant thereto. To that end no person shall, on the grounds of race, color, religion, gender, age, physical or mental disability, sexual orientation, creed, or national origin be excluded from employment, board membership and/or client services at the Boys & Girls Clubs of Wayne County.

It is the continuing policy of the Boys & Girls Clubs of Wayne County to afford equal opportunity to all qualified employees or applicants in the employment, compensation, promotion, upgrading, and termination.
Please Initial saying you have read this section.*

AT-WILL EMPLOYMENT:
Employment with Boys & Girls Clubs of Wayne County is at-will. This means that neither you nor Boys & Girls Clubs of Wayne County, Inc. has entered into a contract regarding the duration of your employment. You are free to terminate your employment with Boys & Girls Clubs of Wayne County at any time, with or without reason. Likewise, Boys & Girls Clubs of Wayne County has the right to terminate your employment, or otherwise discipline, transfer, or demote you at any time, with or without reason.

No employee of Boys & Girls Clubs of Wayne County can enter into an employment contract for a specified period of time, or make any agreement contrary to this policy without written approval from the Executive Director or Board of Directors.
Please Initial saying you have read this section.*

CANDIDATE INFORMATION:
Name*

First NameMiddle NameLast Name
Email:
Date of Birth (MM/DD/YYYY)*

MonthDayYear
Date
Gender*
Shirt Size*
*Used only in the event that the organization orders apparel for the staff for events or other activities.
Anticipated Start Date*

MonthDayYear
Date
Current Address*

Current Address

Street Address Line 2

CityState

Zip Code
Previous Address*

Former Address

Street Address Line 2

CityState

Zip Code
Home Phone
Format: (000) 000-0000.
Cell Phone*
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Are you authorized to work in the United States?*
Position Interested in*

SECURITY:
Consistent with relevant law, the information on this application will not be disclosed to unauthorized persons.
YesNo
Other Name
Other SSN
Date Used

MonthDayYear
Date
Other Name
Other SSN
Date Used

MonthDayYear
Date
Other Name
Other SSN
Date Used

MonthDayYear
Date
List all states and countries in which you have lived since the age of 18. (List in chronological order starting with the most recent
State
Country
State
Country
State
Country
State
Country
State
Country
State
Country
State
Country
State
Country
State
Country
State
Country

EDUCATION, SKILLS, AND INTEREST:
YesNo
If yes, what high school or facility did you attend?
YesNo
If yes, what college or trade school?
If yes, when did you graduate?
If yes, what is your degree in?

EMPLOYMENT / VOLUNTEER HISTORY:
You may attach a Resume to include at least three (3) references (one reference must be a family member and the other two from previous/current employers) or attach additional sheet(s) with information listed below (9 categories Identify all employers for whom you have worked in the last 10 years. Include part-time & temporary employers. Start with your most recent employer. Describe your activities during any lapses in employment in the last 10 years. Do not include leave or time off due to illness or medical treatment. Attach this information to the completed application. If you attach a Resume for this section, it MUST include three references with one reference being a family member. If you attach a Resume, you must complete the remainder of this application or it will be considered as incomplete.
1. Employer/Organization
2. Supervisor’s Name
3. Area Code/Phone Number
4. Location
5. Job/Volunteer Title(s)
6. Job Duties
7. Dates Employed/Volunteered
8. Reason for Leaving
9. Three References (see above)
Please Initial saying you have read this section.*
Resume / Reference Upload*

File types accepted are: PDF, DOC, DOCX, | Max number of files is 1. | Max file size is 10MB
Cancelof
If you have uploaded a resume that includes the following questions, you may scroll down and select Next to move on to the next section. PLEASE be sure that the information is included in the resume. If it is not, the application will be ignored and considered incomplete.
Please select a option, for how you will be providing previous employment experience.*
Employer
Supervisor
Phone
Format: (000) 000-0000.
EXT
Address
City
State
Job Title
Dates(s) Employed (Start / End )
Reason for Leaving
Employer
Supervisor
Phone
Format: (000) 000-0000.
EXT
Address
City
State
Job Title
Dates(s) Employed (Start / End )
Reason for Leaving
Employer
Supervisor
Phone
Format: (000) 000-0000.
EXT
Address
City
State
Job Title
Dates(s) Employed (Start / End )
Reason for Leaving
Employer
Supervisor
Phone
Format: (000) 000-0000.
EXT
Address
City
State
Job Title
Dates(s) Employed (Start / End )
Reason for Leaving

LICENSE, CERTIFICATIONS, SPECIAL SKILLS:
Type
License /Certificate #
Expiration Date

MonthDayYear
Date
Issued By
Type
License / Certificate #
Expiration Date

MonthDayYear
Date
Issued By
Type
License/Certificate #
Expiration Date

MonthDayYear
Date
Issued By
Type
License/Certificate #
Expiration Date

MonthDayYear
Date
Issued By

REFERENCES - MUST LIST AT LEAST THREE - ONE MUST BE A FAMILY MEMBER
If you have uploaded a resume that includes the following questions, you may scroll down and select Next to move on to the next section. PLEASE be sure that the information is included in the resume. If it is not, the application will be ignored and considered incomplete.
Name*
Relationship*
Years Known*
Address*
City*
State*
Occupation*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name*
Relationship*
Years Known*
Address*
City*
State*
Occupation*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name*
Relationship*
Years Known*
Address*
City*
State*
Occupation*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name
Relationship
Years Known
Address
City
State
Occupation
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.

EMERGENCY CONTACT:

(Whom can be contacted in the event of an emergency if employed?)
Name*
Relationship*
Home Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
EXT
Cell Phone*
Format: (000) 000-0000.
Name
Relationship
Home Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
EXT
Cell Phone
Format: (000) 000-0000.

APPLICANT'S STATEMENT
I hereby authorize all employers, organizations, and other entities and persons identified in this form to release any information contained in their files or records concerning me.

In consideration of the receipt and evaluation of this application by Boys & Girls Clubs of Wayne County, I hereby release the Club and any individual, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application.

I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF, AND I SIGN THIS RELEASE AS MY OWN FREE ACT.

I understand and agree that it is critical to Boys & Girls Clubs of Wayne County that all employees and volunteers conform to the highest standards of safety, interpersonal conduct, and sexual morality when clients or minors are involved. I affirm that I will strictly comply with Boys & Girls Clubs of Wayne County policies and procedures, including those concerning child safety and protection, sexual abuse and misconduct, and interpersonal relationships. I understand and agree that failure by me to abide by such policies and procedures may result in my immediate dismissal, or disciplinary action, all in the discretion of Boys & Girls Clubs of Wayne County. My responses above are truthful and accurate. I understand and agree that if they are not truthful and accurate, Boys & Girls Clubs of Wayne County may determine that I am no longer qualified to be associated with its programs as an employee or volunteer in any capacity.
By checking this box, I agree that I have carefully read the following statement. I also am agreeing that I fully understand it.
Applicant's Name (Print)*
Applicant's Signature*
Date*

MonthDayYear
Date

CRIMINAL BACKGROUND CHECK AND BARRIER CRIME POLICY
The Club is committed to selecting and retaining the best staff and volunteers to serve its youth. As part of the initial selection process and on an on-going annual basis, Clubs will conduct background checks in accordance with the following policy:

The Club will conduct criminal background checks on all employees and volunteers, including minors, who have direct, repetitive contact with children. Name-based or fingerprint-based record searches may be used in any combination but shall, at a minimum, (a) verify the person’s identity and legal aliases, (b) provide a national Sex Offender Registry search, and (c) provide a national criminal record search. Such checks shall be conducted prior to employment and at regular intervals not to exceed twelve (12) months to ensure employees and volunteers remain in compliance.

All background check findings shall be considered when making employment or volunteer decisions. It is the policy of the Club that an employee or volunteer will be automatically ineligible for employment or volunteer service, if such individual:
1. Refuses to consent to a criminal background check,
2. Makes a false statement in connection with such criminal background check,
3. Is registered, or is required to be registered on a State or National sex offender registry,
4. Has been convicted of a felony consisting of but not limited to
  1. Murder
  2. Child abuse
  3. Domestic violence
  4. Abduction or human trafficking
  5. A crime involving rape or sexual assault
  6. Arson
  7. Weapons
  8. Physical assault or battery
  9. Drug possession, drug use or distribution of drugs in the last five years;
5. Has been convicted of any misdemeanor or felony:
  1. Against children, including child pornography
  2. Cruelty to animals
OTHER CRIMES that may require further investigation of the applicant or employee before any action is determined:
1. Any misdemeanor convictions within the past 5 years that are not Barrier Crimes.
2. Barrier Crimes are listed in this section titled “Background Check and Barrier Crime Policy” (#a – #e).
3. Incomplete disposition of any Barrier Crime (listed above).
4. Expunction, restoration of rights or pardon of any Barrier Crime.
5. A charge involving a child, but resulting in a favorable disposition to the applicant.
6. A charge not readily apparent if drugs, alcohol, stalking or violence is involved.
7. Any DUI/DWI conviction within the past 5 years.
I have read and understand the Criminal Background Check and Barrier Policy.

For continued employment, return this document, signed and dated, to the Administrative office.
By checking this box, I agree that I have carefully read the following statement. I also am agreeing that I fully understand it.
Applicant's Name (Print)*
Applicant's Signature*
Date*

MonthDayYear
Date

BACKGROUND CHECK PERMISSION FORM
In connection with my application for placement, I understand that an investigative report will be requested that includes information as to my character, work habits, performance, and experience along with reasons for disciplinary action or termination of past employment. I understand that as directed by policy and consistent with the job described, you may be requesting information from public and private sources about my criminal record, driving record, education, and previous employment.

The fact applicants have a criminal record will not be an automatic bar to employment or volunteer work. Factors such as age at the time of the criminal offense, seriousness and nature of the violation, time elapsed and subsequent rehabilitation will be considered.

I acknowledge that a telephonic facsimile (fax) or photographic copy shall be valid as the original. This release is valid in most federal, state, and county agencies.

I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, or other organization or person contacted by the employer or its agent to furnish the information described above.

Law enforcement agencies and other entities for positive identification purposes require the following information when checking records. It is confidential and will not be used for any other purpose.

VeriScreen®

Comprehensive Background Checks

AUTHORIZATION AND RELEASE TO OBTAIN INFORMATION for Boys and Girls Clubs of Wayne County Under the provisions of the Fair Credit Reporting Act, 15 USC, Section 1681 et seq., the Americans with Disabilities Act and all applicable federal, state, and local laws, I hereby authorize and permit VeriScreen, Inc. to obtain a consumer report and/or an investigative consumer report which may include the following:

1.      My employment records;

2.      Records concerning any driving, criminal history, credit history, civil record, workers' compensation (post-offer only) and drug testing;

3.      (For truck drivers only) In accordance with the Department of Transportation Motor Carrier Safety Regulations, Section 382.413, information concerning alcohol and controlled substances for the past 3 years;

4.      Verification of my academic and/or professional credentials; and information and/or copies of documents from any military service records.

I understand that an "investigative consumer report" may include information as to my character, general reputation, personal characteristics, and mode of living, which may be obtained by interviews with individuals with whom I am acquainted or who may have knowledge concerning any such items of information. I am entitled to know if employment or promotion is denied because of information obtained by my prospective employer from a Consumer Reporting Agency.

I agree that a copy of this authorization has the same effect as an original and if my application is accepted I understand that VeriScreen will be allowed to perform a background check on a yearly/quarterly or during the process of determining a promotion, re-certification, continued qualification or as the result of reasonable suspicion. I understand and acknowledge that under provision of the Fair Credit Reporting Act I may request a copy of any consumer report from the consumer reporting agency that compiled the report, after I have provided proper identification.

I authorize VeriScreen, Inc. to obtain and prepare an investigative consumer report as set forth above, as part of its investigation of my application as a volunteer or employee of Boys and Girls Club. This authorization shall remain in effect over the course of my employment or time while volunteering. Reports may be ordered periodically during the course of my employment or volunteering. NOTE: Except for those states where an annual release is required, i.e. California (CALIFORNIA- Continuing consent concept is inapplicable and a separate authorization must be requested each time a report is ordered. - CA Civ. Code 1786.22)

New York and Maine applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by the Boys and Girls Club by contacting the consumer reporting agency identified above directly. You may also contact the Company to request the name, address, and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries, which the Company shall provide within 5 days.

New York applicants or employees only: Upon request, you will be informed whether or not a consumer report was requested by the Boys and Girls Club and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.

Oregon applicants or employees only: Information describing your rights under federal and Oregon law regarding consumer identity theft protection, the storage and disposal of your credit information, and remedies available to you should you suspect or find that the Company has not maintained secured records is available to you upon request.

Washington State applicants or employees only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.

California applicants or employees only: By signing below you also acknowledge receipt of the Notice Regarding Background Investigation Pursuant to California Law. Please check this box and return this page if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California Law.

Minnesota and Oklahoma applicants or employees only: Please check this box and return this page if you would like to receive a copy of a consumer report if one is obtained by the Company.
Please Initial saying you have read this section.*

BACKGROUND CHECK PERMISSION SIGNATURE FORM
Name*

First NameMiddle NameLast Name
Previous / Other Names
Date of Birth (MM/DD/YYYY)*

MonthDayYear
Date of birth is being requested only for the purpose of identification in obtaining accurate retrieval of records, and will not be used for discriminatory purposes.
Gender*
While we try to make sure we are inclusive, for legal obligations, we are required to gather your legal gender for the background check.
SSN*
Names as Appears on License/ID*
Driver's License State*
Driver's License #*
Address*

Address

Street Address Line 2

CityState

Zip Code
Home Phone
Format: (000) 000-0000.
Cell Phone*
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
We acknowledge that this document contains sensitive information. We assert that all copies will be shredded or secured.

CODE OF CONDUCT FOR EMPLOYEES
Each employee has an obligation to observe and follow the Clubs’ policies and to maintain proper standards of conduct at all times. Violations of any of these policies and procedures are considered misconduct and appropriate disciplinary procedures will be initiated that may result in disciplinary action, up to and including termination of employment.

The organization’s reputation is built on a dedication to high standards of conduct. To maintain this reputation, it requires the vigilance and active participation of every employee. The opinions and attitudes that people have towards the Club may be influenced for a long period of time by the behavior and action of one employee. Each employee must be sensitive to the importance of fair and courteous treatment in all work relationships. An employee must project a professional image and maintain the standards of conduct expected of all Club employees.

It is not possible to list all the forms of behavior that are considered unacceptable in the workplace. The following is not all-inclusive but provides an example of improper conduct.

This document will be included in the hiring packet to be signed, dated, placed in your personnel file and renewed annually.

General
- Encourage and enforce proper personal boundaries between persons at the Club.
- Be mindful of the personal boundaries between all persons.
- Treat members as your responsibility, but not as your children, peers or siblings.
- Avoid displaying favoritism or intimacy with any member.
- Avoid inappropriate materials, language, gestures or touching.
- Avoid one-on-one situations with members. (Doors open if a one-on-one situation occurs)
- Avoid off-site fraternization with members.
Physical Contact
- Utilize verbal expressions of approval and encouragement in lieu of physical contact, whenever possible.
- It is advisable for staff to express themselves to members via physical contact through handshakes, fist bumps or “high-fives.”
- A hug, pat on the back or placing arms around the shoulders of a member should only be done in public or plain view of others.
- Do not let members hang on you or sit in your lap.
- Do not touch members through a pat on the buttocks, backrub, massage or other similar touching.
- Physical contact between staff and members during athletic activities must be Club supervised.
Technology and Other Media - The following are not allowed:
- Any material that is sexually explicit, provocative, inappropriate, unwholesome or unprofessional on any computer or personal digital assistant (PDA) in the Clubhouse or any computer or PDA owned by the organization
- Communications to other staff or members that is unprofessional, inappropriate or unwholesome
- Communications with members by email, text message, instant message or any social media except via their Club email address
- Sharing home or personal email, instant message or social media addresses with members
- Communication with Club members through social media platforms except via the Club’s social media pages (such as but not limited to Facebook, Instagram, twitter)
- Sharing any magazines, literature, photos, videos or music with members that would be considered inappropriate or “adult” in nature. Such materials shall not be present on Club premises.
- Any inappropriate personal photos in their office or on their person.
Verbal Communication - The following are not allowed:
- Using language of a sexual, vulgar or provocative nature
- Speaking in a teasing, deriding or sarcastic tone
- Sharing personal information with members, such as one’s love life, sex life, romances or other similar information
- Sharing your personal phone number with a member
- Communications with members by telephone/cell phone for social or any other purposes except for Club matters
The Appearance of Impropriety
- There should be few, if any, instances when staff must be alone with a member.
- If you confer with a member, the office or room door must always be open, even if the member wishes to speak in confidence.
- Do not let members wear your clothes or have access to your personal belongings.
- Avoid being alone in a locker room with a member who is showering or changing clothes.
Accusations of Impropriety
- Record keeping is a necessary means of protecting all staff and members. If you are accused of impropriety or are a witness to an incident that is the basis of such an accusation, write down all details (date, time, who was present, who said what, who did what) before the memory fades.
- In the course of an investigation into accusations of impropriety, you must never withhold information or provide false or misleading information out of loyalty to a friend or coworker.
- All staff hold positions of responsibility, and your first obligation is to the emotional, physical and mental well-being of the members who are entrusted to your care.
Transportation
- Staff may not drive alone in a vehicle with a member without permission from the Executive Director.
- On Club trips, adult staff shall never share a room with a member or be alone in a room with members.
- On Club trips, beds, blankets or sleeping bags should not be shared between staff and members.
Secrets and Confidentiality
- If a member asks a staff member not to reveal a secret, the staff member should advise the member that in some instances they may be required to reveal the secret, especially if the secret carries potential harm to themselves or others. In such cases the staff must reveal it to the proper authorities.
By checking this box, I agree that I have carefully read the following statement. I also am agreeing that I fully understand it.
Applicant's Name (Print)*
Applicant's Signature*
Date*

MonthDayYear
Date
If for any reason, the spaces provided were insufficient, you may now upload up to 4 files with explanations for any of the questions asked in this application.

File types accepted are: PDF, DOC, DOCX, TXT, RTF | Max number of files is 4. | Max file size is 5MB per file.
Cancelof
Should be Empty:

Employment / Volunteer Application

APPLICANT INSTRUCTIONS:

APPLICANT NOTE:

EQUAL OPPORTUNITY EMPLOYMENT:

AT-WILL EMPLOYMENT:

CANDIDATE INFORMATION:

SECURITY:

VOLUNTEER AND/OR JOB-RELATED SKILLS:

DISCIPLINARY AND LEGAL BACKGROUND:

EDUCATION, SKILLS, AND INTEREST:

EMPLOYMENT / VOLUNTEER HISTORY:

LICENSE, CERTIFICATIONS, SPECIAL SKILLS:

REFERENCES - MUST LIST AT LEAST THREE - ONE MUST BE A FAMILY MEMBER

EMERGENCY CONTACT:

APPLICANT'S STATEMENT

CRIMINAL BACKGROUND CHECK AND BARRIER CRIME POLICY

BACKGROUND CHECK PERMISSION FORM

BACKGROUND CHECK PERMISSION SIGNATURE FORM

CODE OF CONDUCT FOR EMPLOYEES