Employment Application | Boys & Girls Club of Delaware County

An Equal Opportunity Employer

First Name *

Middle Initial *

Last Name *

Other Names Used

Telephone (Area Code)

Street Address *

Apartment, suite, etc

City *

State *

ZIP code *

Country

Date of Birth *

Month *

Day *

Year *

Social Security Number *

Are you a resident of the United States? *YesNoIf you are a resident alien, please give your alien number or present your resident alien card.

Are you at least 18 years of age? If not do you have a work permit? *YesNo

HOW WERE YOU REFERRED TO BOYS & GIRLS CLUBS OF DELAWARE COUNTY?

RELATIVES EMPLOYED BY B&GC OF DELAWARE COUNTY (If any, give dates, position)

HAVE YOU EVER BEEN EMPLOYED OR VOLUNTEERED AT A BOYS & GIRLS CLUB? *YesNo

Previous Boys and Girls Club History

Name and Location

Date Started

Date Left

HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENSE? *YesNo

Position Applied For

Title or Category

Salary Requested

Date Available

Willingness to travel (Approx. Percentage)

Education

High School

Name and Location

GraduateYesNo

College or University

Name and Location

Major

GraduateYesNo

Degree

Other Schools (graduate, technical, business, military, etc.)

Name and Location

Major

GraduateYesNo

Degree

Work Experience

Company Name

Your Title

Street Address

Suite

City

State/Province

ZIP / Postal Code

Date Started

Date Left

Starting Salary

Ending Salary

Supervisor's Name

Supervisor's Title

Telephone

May we contact Employer?YesNo

Brief Description of Duties & Responsibilities

Reason for leaving

Clerical Applicants

TypeYesNo

Words/Minute

Word ProcessingYesNo

Type

DictationYesNo

Words/Minute