Employment Application - Boys & Girls Clubs of Lanier

I am applying for the following position:*

Name*

First Middle Last

Date*

Present Address*

Street Address Address Line 2 City State ZIP Code

Social Security Number (Last 4 digits)*

Phone*

Mobile Phone

Email*

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 Boys & Girls Clubs of Lanier?*

Were you previously employed with Boys & Girls Clubs of Lanier (BGCL)?*

Yes
No

Please list dates and location of previous employment with BGCL.

Do you have any relatives who are/have been employed by BGCL?*

Yes
No

Please list dates and position of relative's employment.

Have you been convicted of, plead guilty to, and/or plead nolo contendre to a crime (felony or misdemeanor, including but not limited to sexual offender crimes, theft, banking fraud, drug and/or alcohol-related offenses, assault, etc)?*

Yes
No

If yes, please explain.

Provide state, date, court, type of crime, place of occurrence, disposition

POSITION APPLIED FOR

Title or Category*

Salary Requirements*

Date Available*

Willingness to Travel*

Approximate percentage if position indicates

EDUCATION

Did you attend high school?*

High School

Name and location

Date attended

Start date and end date

Did you graduate?

Diploma or Degree Earned

Did/do you attend college?*

College or University

Name and location

Date attended

Start date and end date

Did you graduate?

Diploma or Degree Earned

Do you have any additional educational experience?*

Other Education (Graduate, Technical, business, military, etc.)

Name and location

Date attended

Start date and end Date

Did you graduate?

Diploma or Degree earned

Military Background*

None
Air Force
Army
Coast Guard
Marines
Navy

Dates of Service

Are you a U.S. Veteran?*

Resume*

Can you perform this job (as detailed verbally or in the job description) with or without reasonable accomodation?*

Are you a former Boys & Girls Club member?*