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Employment Application
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Name
*
First
Last
Address: Street/City/State/Zip
*
Phone Number
*
Email
*
Date of Birth
*
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 the Boys & Girls Club?
*
Do you have any previous affiliation with any BGCs?
*
Position Applied For:
*
Salary Requirements
*
Date Available
*
Willingess to travel?
Yes
No
High School
*
Provide the name, city and any relevant degrees or majors.
High School: Did you graduate?
Yes
No
College or other schools
Please provide the name, city and any relevant degrees, certificates or majors.
College or Other: Did you graduate?
Yes
No
Work Experience 1: Name of most recent employer
*
Work Experience 1: Company Address
Work Experience 1: Start Date – End Date
*
Work Experience 1: Starting Salary – Ending Salary
*
Work Experience 1: Supervisor's Name, Title and Phone Number
*
Work Experience 1: Description of duties & responsibilites
*
Work Experience 1: Reason for Leaving?
*
Work Experience 1: May we contact this employer?
*
Yes
No
Work Experience 2: Name of Employer
*
Work Experience 2: Company Address
Work Experience 2: Start Date – End Date
*
Work Experience 2: Starting Salary – Ending Salary
*
Work Experience 2: Supervisor's Name, Title and Phone Number
*
Work Experience 2: : Description of duties & responsibilities
*
Work Experience 2: Reason for Leaving?
*
Work Experience 2: May we contact this employer?
*
Yes
No
Other relevant work experience?
List any additional achievements, abilities or activities that you consider relevant to your application such as computer language or software programs, foreign language (proficiency in speaking and/or writing), etc.
Reference #1
*
First
Last
Reference #1 Phone Number
*
Reference #2
*
First
Last
Reference #2 Phone Number
Statement of Agreement
*
I agree
I do not agree
I understand that my initial employment is contingent upon clearance through a criminal history records, sex offender database, and child abuse and maltreatment database check in accordance with the Fair Credit Reporting Act, Article 23-A of the New York Correction Law, and the social services law.
I understand that Boys & Girls Clubs of Syracuse (BGCS) 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 BGCS’ review of this application and my candidacy for employment, I release BGCS 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 BGCS 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.
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