Club & Sports Application

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POSITION APPLIED FOR

Position*

Salary/Hourly Desired*

Date Available*

Days and times available*

Education

School

Name and Location

Major

Dates: From - To

Graduate: Yes or No

Degree

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:*

REFERENCES

PLEASE NOTE: An email from SkillSurvey will be sent to the email address listed in the general information above. This email will contain a link which will direct you to enter your references information. Your application is not considered complete until your references have been entered in SkillSurvey. You should receive an email from SkillSurvey within 2 business days of handing in this application. Please make sure to check your spam and junk folders if you have not received an email.

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.

Club & Sports Application

POSITION APPLIED FOR

REFERENCES

WORK EXPERIENCE

Employer 1

Employer 2

Employer 3

OTHER INFORMATION

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