Online BGCSWVA Job Application

Job Application

PRE-EMPLOYMENT QUESTIONNAIRE EQUAL OPPORTUNITY EMPLOYER

Name

First Middle Initial Last

Today's Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Information

Best Phone Number

Email Address

U.S. Military or Naval Service (include rank)

(if applicable)

Position Desired

Date you can start

Salary Desired

Are you currently employed?

If so, may we inquire of your present employer?

Have you ever worked or volunteered at any Boys & Girls Club? If so, where and provide service dates.

Name and Location of High School(Required)

Years Attended(Required)

Did you graduate?(Required)

(Must have graduated high school or have earned a GED to be considered for employment.)

Subject Studied

College

Years Attended

Did you graduate?

Subject Studied

Trade, Business, or Correspondence School

Years Attended

Did you graduate?

Subject Studied

Former Employer 1

Dates Employed (from-to)

Name, City, State of Employer

Salary

Position

Reason for Leaving

Former Employer 2

Dates Employed (from-to)

Name, City, State of Employer

Salary

Position

Reason for Leaving

Former Employer 3

Dates Employed (from-to)

Name, City, State of Employer

Salary

Position

Reason for Leaving

Reference 1(Required)

List three people whom you have known at least one year who are not family members.

Name

City, State

Phone Number

Personal/Business

Years Known

Reference 2(Required)

Name

City, State

Phone Number

Personal/Business

Years Known

Reference 3(Required)

Name

City, State

Phone Number

Personal/Business

Years Known