INTERNSHIP APPLICATION

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Important: Please read carefully before signing.

A consumer report and/or investigative consumer report including information concerning your character, employment history, general reputation, personal characteristics, police record, criminal records, education, qualifications, motor vehicle record, mode of living and/or credit and indebtedness may be obtained in connection with your application for and/or continued employment with the employer. A consumer report and/or an investigative consumer report may be obtained at any time during the application process or during your employment with the company. These reports may include experience information along with reasons for termination of past employment. Further, understand that information from various Federal, State, local and other agencies which contain your past activities may be requested.

The name, address and telephone number of the Company preparing the report is: First Advantage P.O. Box 3367 Seminole, FL 33775-3367; Toll free number: 1-800-321-4473 ext. 8. Their privacy Policy can be reviewed at http://www.fadv.com/privacy-policy. A secondary report may be obtained through Washington Access to Criminal History (WATCH).

Before any adverse action is taken, based in whole or in part on the information contained in the consumer report, you will be provided a copy of the report, the name, address and telephone number of the reporting agency, and a summary of your rights under the Fair Credit Reporting Act.

A copy of your report will be available upon request.

By signing below, you hereby authorize without reservation, any party or agency contacted by this employer to furnish the above mentioned information. You further authorize ongoing procurement of the above mentioned reports at any time during your employment (or contract). You also agree that a fax or photocopy of this authorization with your signature be accepted with the same authority as the original.

You hereby authorize and request, without any reservation, the Boys & Girls Clubs of Southwest Washington to furnish First Advantage and/or WATCH with any and all background information in their possession regarding you, in order that your employment qualifications may be evaluated.

The following is for identification purposes only to perform the background check:

I understand that Boys & Girls Clubs of Southwest Washington (BGCSW) will attempt to verify statements made on my application and made during my employment interview. I hereby give my permission for my former employers to answer any and all questions based upon information available to them in my prior employment records. I understand that it is possible that my prior employment records may not be accurate. Nonetheless, in consideration of BGCSW's review of this application and my candidacy for employment, I release BGCSW and all former employers from any liability as a result of the furnishing and receiving of this reference information. I understand that my failure to sign this reference release so BGCSW can contact references and make a full background check of my previous work history will be deemed interference with and a withdrawal of my application for employment.

I understand that BGCSW requires certain information about me to evaluate my qualifications for employment and conduct its business if I become an employee. I understand that false, incomplete, or misleading statements on this application may be considered sufficient cause for rejection of my application and for dismissal, if discovered after I am employed by BGCSW. The use of this application does not indicate there are positions open and does not in any way obligate BGCSW.

I also authorize BGCSW to supply information about my employment record, in whole or in part, in confidence to any prospective employer, government agency, or other party having a legal and proper interest, and I hereby release BGCSW from any and all liability for its providing this information. I understand that I have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope of this investigation.

I understand that employment may be conditional upon a satisfactory drug test and understand that if I refuse to take or fail a drug test I will not be employed. I further agree that if I am employed I will be subject to drug and alcohol testing if there is reasonable suspicion that I am using drugs or reasonable cause to believe that I am under the influence of alcohol.

In consideration of my potential employment, I agree to conform to the rules of BGCSW. I understand that I have the right to terminate my employment at any time with or without notice, with or without cause, and that BGCSW has a similar right. I understand my employment by BGCSW does not constitute a guarantee that any position be continued for any length of time or that any job assignment or shift be permanent.

I understand that I may be required to work scheduled and unscheduled overtime and scheduled weekend and holiday work when required by BGCSW. I also understand that BGCSW 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 no one other than the Chief Professional Officer of BGCSW has authority to make any other agreement.

The Immigration Reform and Control Act of 1986 requires that, after employment, employers verify the legal work authorization and identity of all new employees. An offer of employment will depend upon BGCSW's ability to verify this necessary information.

Applications will not be considered active after the position is filled. I understand that BGCSW will attempt to verify statements made on my application and made during my employment interview.

EQUAL OPPORTUNITY EMPLOYER: BGCSW prohibits discrimination against current staff or applicants on the basis of sex (including pregnancy, childbirth or related medical conditions), race, religion, color, national origin, physical or mental disability, protected medical condition, marital status, age, sexual orientation, gender identity, ancestry, military or veteran status, genetic information or any other characteristic protected by federal, state, or local law. BGCSWWA is an equal opportunity employer.