Employment Application

GENERAL

Note: Conviction of a crime will not necessarily disqualify you for employment. Each conviction will be judged on its own merit with respect to time and job relatedness.

POSITION APPLIED FOR

EDUCATION

WORK EXPERIENCE

Please complete all information, beginning with your current or most recent employer. Include periods of unemployment, self-employment, and military service.

Company 1

Company 2

Company 3

REFERENCES (Not Relatives)

Reference 1

Reference 2

Reference 3

AUTHORIZATION TO RELEASE EMPLOYMENT REFERENCE INFORMATION

I understand that Boys & Girls Club of Poplar Bluff 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 Boys & Girls Club of Poplar Bluff’s review of this application and my candidacy for employment, I release Boys & Girls Club of Poplar Bluff 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 Boys & Girls Club of Poplar Bluff 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.

JOB APPLICANT AGREEMENT

I understand that Boys & Girls Club of Poplar Bluff 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 dismissal, if discovered after I am employed by Boys & Girls Club of Poplar Bluff. The use of this application does not indicate there are positions open and does not in any way obligate Boys & Girls Club of Poplar Bluff.

I also authorize Boys & Girls Club of Poplar Bluff 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 Boys & Girls Club of Poplar Bluff from any and all liability for its providing this information. I understand that I have the right to make a written request within reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope of this investigation.

In consideration of my potential employment, I agree to conform to the policies/rules of Boys & Girls Club of Poplar Bluff. I understand that I have the right to terminate my employment at any time with or without notice, with or without cause, and that BGCA has a similar right. I understand my employment by Boys & Girls Club of Poplar Bluff 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/unscheduled overtime, scheduled weekends, and holiday work when required by Boys & Girls Club of Poplar Bluff. I also understand that Boys & Girls Club of Poplar Bluff 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 President of the Board of Directors or Executive Director/Human Resources of Boys & Girls Club of Poplar Bluff has the 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 Boys & Girls Club of Poplar Bluff’s ability to verify this necessary information.

Applications will not be considered active after the position is filled. I understand that Boys & Girls Club of Poplar Bluff will attempt toverify statements made on my application and made during my employment interview.