Date of Application *

General Information

First Name *

Last Name *

M.I.

Other Names Used

Current Address *

Mailing Address *

Email *

Are you authorized to work in the United States? *

Yes

If no, do you have a work permit? *

Yes

Are you at least 18 years of age? *

Yes

If no, how old are you? *

How were you referred to the Boys & Girls Club of Cuero (BGCC)? *

Previous employment with BGCC? (if any, give dates, position, location) *

Relatives Employed with BGCC? (if any, give dates, positions) *

Have you ever been convicted of, plead guilty to, and/or plead nolo contendere to a crime (felony or misdemeanor, including but not limited to sexual offender crimes, theft, banking card fraud, drug and/or alcohol-related offenses, assault, etc.)? *

Yes

NOTE: Conviction of crime will not necessarily disqualify you for employment. Each Conviction will be judged on its own demerit with respect to time and job relatedness.

If yes, please explain (state, date, court, type of crime, place of occurrence, disposition): *

Position Applying For

Position Title: *

Salary Requirements *

Date Available *

Willingness to Travel? *

Yes

Education

Which high school did you attend? *

Did you graduate? *

Yes

If no, what year do you expect to graduate? *

College or University? *

Location *

Did you graduate from College/University? *

Yes

Degree Type *

Other Schools (Graduate, Technical, Business, Military, etc.) *

Work Experience

If you have a resume, upload here

Work Experience (Current/Most Recent) *

Company Name
Your Title
Company Address
Start Date
End Date
Starting Salary
Ending Salary
Supervisor's Name & Title
Phone
May we contact employer?
Brief description of duties/responsibilities
Reason for Leaving

Do not detail duties and responsibilities if described in attached resume.

Work Experience (Previous) *

Company Name
Your Title
Company Address
Start Date
End Date
Starting Salary
Ending Salary
Supervisor's Name & Title
Phone
May we contact employer?
Brief description of duties/responsibilities
Reason for Leaving

Do not detail duties and responsibilities if described in attached resume.

All Applicants

Please list all software application skills: *

Please list at least two references: *

Name
Phone Number
Name
Phone Number

Drug-Free Policy Form

All employees are required are required to read the Boys & Girls Club of Cuero policy concerning the drug-free workplace. Employees are also required to sign and detach the form following the policy statement. The signed form will be placed in the employee’s personnel folder.

The following policy is from the Boys & Girls Club of Cuero policy Manual:

DRUG FREE WORKPLACE

1. Possession, use, distribution, or being under the influence of illicit drugs or alcohol is prohibited in any club facility and/or any Club function or activity.

2. Employees who violate this this prohibition will be subject to immediate dismissal from

employment and possible referral for prosecution.

3. Compliance with these provision and prohibition is mandatory condition of employment.

4. Drug and alcohol counseling, rehabilitation, and re-entry programs are available to employees. A list of such programs is available upon request to the Executive Director.

5. The Club will review its drug-free workplace policy annually.

6. All buildings are smoke free.

Drug-Free Policy Signature Form

I have read the drug-free policy for the Boys & Girls Club of Cuero and will abide by the policy set forth by this organization.

Signature *

Clear

Date *