BOYS & GIRLS CLUB OF GREATER HOLYOKE, INC.

EMPLOYMENT APPLICATION

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, martial or veteran status, sexual orientation, or any other legally protected status.

Position or Job Title Applying For:
How Did You Learn About Us?:
Name:
Address:*
Phone:*
-
E-mail:*
If you are under 18 years of age, can you provide required proof of your eligibility to work?:
Have you ever been employed with us before?:
If yes, give date:
Are you currently employed?:
May we contact your present employer?:
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?:

(Proof of Citizenship or immigration status will be required upon employment.)

On what date would you be available for work?:
What Days/Hours Are You Available To Work?:

Do you have any objections for a CORI and a SORI? A CORI (Consent for Criminal Records Check) and/or a SORI (Sex Offender Registry Check) will be obtained for all employees/prospective employees. Do you have any objections for a CORI and a SORI?

CORI and a SORI? A CORI (Consent for Criminal Records Check):

EDUCATION

1. Elementary School

Elementary School Name
Elementary School Address:
Elementary Course of Study:
Elementary Years Completed:
Elementary Diploma Degree:

2. High School

High School Name
High School Address:
High Course of Study:
High Years Completed:
High Diploma Degree:

3. Undergraduate College

Undergraduate School Name:
Undergraduate School Address:
Undergraduate Course of Study:
Undergraduate Years Completed:
Undergraduate Diploma Degree:

4. Graduate College

Graduate School Name:
Graduate School Address:
Graduate Course of Study:
Graduate Years Completed:
Graduate Diploma Degree:

4. Other Education

School Name:
School Address:
Course of Study:
Years Completed:
Diploma Degree:

EMPLOYMENT EXPERIENCE

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

1. Employer Name:
1. Employer Address:
1. Dates Employed:
1. Phone:
-
1. Hourly Rate/Salary:
1. Job Title:
1. Supervisor:
1. Work Performed:

2. Employer Name:
2. Employer Address:
2. Dates Employed:
2. Phone:
-
2. Hourly Rate/Salary:
2. Job Title:
2. Supervisor:
2. Work Performed:

3. Employer Name:
3. Employer Address:
3. Dates Employed:
3. Phone:
-
3. Hourly Rate/Salary:
3. Job Title:
3. Supervisor:
3. Work Performed:

4. Employer Name:
4. Employer Address:
4. Dates Employed:
4. Phone:
-
4. Hourly Rate/Salary:
4. Job Title:
4. Supervisor:
4. Work Performed:

LANGUAGES

Indicate any foreign Languages you can speak, read and/or write.

Languages you can speak, read and/or write:

Other Qualifications

List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:
Describe any specialized training, apprenticeship, skills and extra-curricular activities. Example: First Aid, CPR, Life Guarding:
Summarize special job-related skills and qualifications acquired from employment or other experience:
State any additional information you feel may be helpful to us in considering your application:

REFERENCES

Other than relatives and past employer.

1. Reference Name:
1. Reference Address:
1. Reference Phone:
-

2. Reference Name:
2. Reference Address:
2. Reference Phone:
-

3. Reference Name:
3. Reference Address:
3. Reference Phone:
-

RESUME

Attach your resume.

Upload a your resume:

Applicant’s Statement

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I give my permission to be used in public relation materials.:
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