Employment Application Form

Our organization views protecting children and youth as an integral part of our mission. We have a zero-tolerance policy for child abuse and mistreatment of any kind in our organization and consistently employ many policies and practices to ensure the safety of children in our care.

Personal Information

Name*

First NameLast Name

Birth Date*

MonthDayYear

Phone Number*

Email*

example@example.com

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How were you referred to us?

If it was by a current employee, please put their full name

Are you at least 15 years old?*

YesNo

Social Security Number:*

Shirt Size: *

Do you have relatives employed with us? If yes, please provide their name(s)

Have you previously worked at this Boys & Girls Club OR another Boys & Girls Club?*

YesNo

If yes, provide organization name and supervisor contact information

Have you previously be convicted of a criminal offense?*

YesNo

If yes, please explain:

Employment Information

Position Applying for:*

Program Leader - minimum age 19Program Assistant - minimum age 15Development Coordinator

Employement desired time frame:*

After-school only

Hourly pay desired:*

Date Available to start:*

Date

Days available:*

Hours available:*

Education

Current or highest level of Education: *

Name of School:*

Graduation/anticipated date: *

Major:

Interests (Clubs, sports, hobbies):*

Do you have a current CPR/First Aid Certificate?*

YesNo

Work or Volunteer Experience

Begin with current or most recent experience

Experience - One

Company Name:

Employment Dates:

Ending Pay:

Supervisors Name:

Supervisors Email:

Supervisors Phone:

May we contact employer?

YesNo

Brief Description of Duties:

Reason for leaving:

Experience - Two

Company Name:

Employment Dates:

Ending Pay:

Supervisors Name:

Supervisors Email:

Supervisors Phone:

May we contact employer?

YesNo

Brief Description of Duties:

Reason for leaving:

References

MUST include ONE family member

Reference*

Authorizations

I authorize Boys & Girls Club of Cooke County (BGCCC) to investigate all statements in the application and to secure any necessary information from all my employers, references and academic institutions. I herby release all of those employers, references, academic institutions and BGCCC from any and all liability arising from their giving or receive information about my employment history, my academic credentials or suitability for employment with BGCCC. I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning my academic credentials and employment references.

I further understand that any false or misleading statements will be sufficient cause for rejection of my application if BGCCC has not employed me or immediate dismissal if BGCCC has employed me. I also authorize BGCCC to supply information about my employment record, in who or in part,, in confidence to any prospective employer, government agency or other party having legal and proper interest, and I herby release BGCCC from any and all liability for its providing this information.

I understand that nothing in the employment application, in BGCCC's policy statements or personal guidelines, or in my communications with any BGCCC official is intended to create an employment contract between BGCCC and me. I also understand that BGCCC has the right to modify its policies without giving me any notice of the changes. No promises regarding employment have been made to me. I understand that if any employment relation is established, I have the right to terminate my employment at any time for any reason. I also understand that BGCCC retains the right to terminate my employment at any time for any reason.

I hereby acknowledge that I have read and understood the above statements. Please sign your name below: *