Employment Application Form

Youth Development Professional

Part Time/Full Time
Name:*

First NameMiddle InitialLast NameSuffix
Birth Date*

MonthDayYear
Other Names by which you have been known (if any)

First NameMiddle InitialLast Name
E-mail Address:*
Mobile Phone*

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relatives Currently or Formerly Employed at BGC Sweetwater County
First NameMiddle InitialLast Name
First NameMiddle InitialLast Name

Employment History

Start with your current or most recent employer and work backwards regarding past 3 former employers.
Current or Most Recent Employer:*
Name of Employer
Company Address
Address
City, State Zip
City, State, Zip
Job Title
Last Position You Held:
Supervisor Name
Immediate Supervisor(s)
Company Phone
Phone Number(s)
Responsibilities
List all Responsibilities
Job info

Dates of EmploymentMost Recent Salary or Hourly Rate
Hours worked per Week Reason for Leaving
May we Contact this Employer?*
Next Recent Employer:
Name of Employer
Company Address
Address
City, State Zip
City, State, Zip
Job Title
Last Position You Held:
Supervisor Name
Immediate Supervisor(s)
Company Phone
Phone Number(s)
Responsibilities
List all Responsibilities
Job info

Dates of EmploymentMost Recent Salary or Hourly Rate
Hours worked per Week Reason for Leaving
May we Contact this Employer?
Next Recent Employer:
Name of Employer
Company Address
Address
City, State Zip
City, State, Zip
Job Title
Last Position You Held:
Supervisor Name
Immediate Supervisor(s)
Company Phone
Phone Number(s)
Responsibilities
Job Title and Responsibilities
Job info

Dates of EmploymentMost Recent Salary or Hourly Rate
Hours worked per Week Reason for Leaving
May we Contact this Employer?

Have you ever filed an application for employment with us before?*
Are you looking for full-time or part-time employment?*
Select the time frame you are looking to be employed with us?*
Are you a US Citizen?*
Are you authorized to work in the US?*
Are you currently employed?*
If currently employed and you do not wish for us to contact your employer, please set forth the reasons why:
Have you ever been terminated or forced to resign from your employment with any employer?*
If yes, please explain:
Are you able to pass a background check?*
If no, please explain:
Have you ever been convicted of a crime of any kind including any driving and/or alcohol related offenses?*
If yes, please explain:
Have you ever been employed or volunteered at another Boys & Girls Club?*
If yes, please provide Club name:
Have you ever been employed or volunteered at another youth organization or school?*
If yes, please provide organization/school name:

Do you hold a current First Aid certification?*
Do you hold a current CPR with AED certification?*
By submitting this application, I agree that all information provided is true to the best of my knowledge. If this application leads to employment, I undertand that false or misleading information is my application or interview may result in termination of employment.
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Youth Development Professional