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Employment Application

Please complete the following employment application and submit.  You may also opt to download the application by clicking the link below.  Return the completed application to Joe Habina at the Boys & Girls Club. 

Position(s) Applying For
Program(s) Applying For
Activities you are capable of supervising (Program Support Positions Only)

Educational History

Employment Record

Non-Employment References

Names of those who have supervised you in a NON-EMPLOYMENT setting, such as teachers, coaches, Club directors, etc., are recommended.  Do not include relatives, personal friends, or former employers.


Criminal Offense Record

Answer the following questions completely and accurately.  Any falsifications or misstatements of fact may be sufficient to disqualify you.  If any doubt exists in your mind as to whether or not you were arrested or charged with a criminal offense at some point in your life or whether an offense remains on your record, you should answer "Yes".  You should answer "No" only if you have never been arrested or charged, or your record was expunged by a judge's court order.

Have you ever been arrested by a law enforcement officer, or otherwise charged with a criminal offense, or investigated for carrying out any form of child abuse/neglect or any from of sexual abuse?

I hereby state that all of the information I have provided on this employment application is correct to the best of my knowledge.  I also agree that, if accepted for a position, I will abide by the Rules and Regulations of the Boys & Girls Club and conduct myself in a manner that is conducive to the Boys & Girls Club mission.  I understand that prior to my hiring I must pass a drug test and that any failed drug test during my employment could lead to dismissal.


Program Support Positions Only.  Does not apply to clerical and maintenance related positions.

Questions.  Answer ALL of the following questions in 100-150 words and in complete sentences.

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