Scamps Application

"*" indicates required fields

URL

This field is for validation purposes and should be left unchanged.

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Are you authorized to work in the United States?*

Yes

If you are a resident alien, please give your alien number of present your resident alien card.

List previous affiliation with the Boys & Girls Club of Kenosha or any other youth serving organization

If any, give dates, positions, locations)

List relatives employed with the Boys & Girls Club of Kenosha

Have you ever been convicted of a criminal offense?*

Yes

If yes, please explain:*

POSITION APPLIED FOR

Position*

Salary/Hourly Desired*

Date Available*

Days and times available*

List the hardest skills you can spot or train on the following equipment:

Bars*

Beam*

Rings*

Trampoline*

Tumbling*

Vault*

Education

School

Name and Location

Major

Dates: From - To

Graduate: Yes or No

Degree

References

Please provide the names of three individuals, not related to you and whom you have known for a period of time, who can provide a reference. Do not leave any information blank.

Name

Address, City, State, Zip

Phone (including area code)

Email address

Nature of relationship

Length of relationship

WORK EXPERIENCE

Start with last employer first. Do not detail duties and responsibilities if described in attached resume. Use additional pages if necessary.

Employer 1

Company Name

Your Title

Company Address

Street Address Address Line 2 City State ZIP Code

Date Started

Date Left

Starting Salary

Ending Salary

Supervisor’s Name

Supervisor’s Title

Supervisor’s Telephone (incl. area code)

Brief Description of duties and responsibilities

Reason for leaving

Would you like to add another employer?

Yes

Employer 2

Company Name

Your Title

Company Address

Street Address Address Line 2 City State ZIP Code

Date Started

Date Left

Starting Salary

Ending Salary

Supervisor’s Name

Supervisor’s Title

Supervisor’s Telephone (incl. area code)

Brief Description of duties and responsibilities

Reason for leaving

Would you like to add another employer?

Yes

Employer 3

Company Name

Your Title

Company Address

Street Address Address Line 2 City State ZIP Code

Date Started

Date Left

Starting Salary

Ending Salary

Supervisor’s Name

Supervisor’s Title

Supervisor’s Telephone (incl. area code)

Brief Description of duties and responsibilities

Reason for leaving

OTHER INFORMATION

What languages do you speak fluently?

Do you have a valid driver’s license?*

Yes

If yes, from which State?*

Have you had any moving violations in the past year?*

Yes

If yes, identify type(s) of violation(s) and date(s) of occurrence*

Are you 25 years of age or older (for insurance purposes)?*

Yes

Consent*

I authorize the Boys & Girls Club of Kenosha to investigate all statements in this application and to secure any necessary information from
all my employers, references and academic institutions. I also authorize Boys & Girls Club of Kenosha to conduct criminal records checks or
any other background checks deemed necessary to determine my suitability for employment. I consent to have Boys & Girls Club disclose
my data and data relating to my references to SkillSurvey, and for SkillSurvey to use such data to provide the Services and Software,
including where applicable, receiving automated text messages through SkillSurvey and related communications. I hereby release all of those
employers, references, academic institutions and Boys & Girls Club of Kenosha from any and all liability arising from their giving or
receiving information about my employment history, my academic credentials or qualifications and my suitability for employment with the
Boys & Girls Club of Kenosha. I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning
academic credentials, employment references, background checks and driving record (if applicable).
I understand that my picture/video may be taken by any BGCK staff, volunteer, sponsor or any other BGCK program colleague for media
and/or public relations including, without limitation, use on sponsor owned and operated websites, social media sites, and print and digital
media, and allow for these representations, as well as my e-mail to be used for media and/or public relations purposes unless I submit a
statement to the contrary to appropriate BGCK staff (this does not include volunteer coaching staff). I give permission for the BGCK to share
my contact information with a third party for the purpose of promoting and marketing non-BGCK programs.
I further understand that any false or misleading statements will be sufficient cause for rejection of my application if the Boys & Girls Club
of Kenosha has not hired me or immediate dismissal if the Boys & Girls Club of Kenosha has employed me. I also authorize the Boys &
Girls Club of Kenosha 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 the Boys & Girls Club of Kenosha from any
liability for its providing this information.
I understand that nothing in this employment application, in Boys & Girls Club of Kenosha’s policy statements or personnel guidelines or in
my communications with any Boys & Girls Club of Kenosha official is intended to create an employment contract between the Boys & Girls
Club of Kenosha and me. I also understand that the Boys & Girls Club of Kenosha 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 if an employment relationship is
established, I have the right to terminate my employment at any time for any reason. I also understand that the Boys & Girls Club of
Kenosha retained the right to terminate my employment at any time for any reason.

I agree to the privacy policy.

Signature*

Date*

Equal Opportunity Employer: Qualified applicants receive consideration for employment without discrimination because of gender, age, religion, marital status, sexual orientation, race, color, creed, national origin or disability.

Scamps Application

POSITION APPLIED FOR

WORK EXPERIENCE

Employer 1

Employer 2

Employer 3

OTHER INFORMATION

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