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Employment Application
BACKGROUND INVESTIGATION CONSENT

I hereby authorize Boys & Girls Clubs of North Alabama and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment or service with Boys & Girls Clubs of North Alabama.

I release Boys & Girls Clubs of North Alabama and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims, or lawsuits in regards to the information obtained from any and all of the above referenced sources used.

The following is my true and complete legal name and all information is true and correct to the best of my knowledge.


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Background Investigation Consent *
Required
Full Name *
Position Applying For *
Club Applying For *
Street Address *
City, State *
Zip Code *
Former Street Address *
Former City, State *
Former Zip Code *
Date of Birth *
MM
/
DD
/
YYYY
Social Security Number *
Male/Female *
Race *
Driver's License Number *
State of License *
PERSONAL:
Primary Phone *
Alternate Phone
Email Address *
EDUCATION:
High School *
College
GPA *
Year Degree Received
Major
Activities *
WORK/SERVICE EXPERIENCE (two most recent):
Company - 1 *
Job Title *
Work Address *
Work Phone *
Supervisor *
Dates Worked/Served (from/to) *
Reason for Leaving *
May we contact this employer? *
Company - 2 *
Job Title *
Work Address *
Work Phone *
Supervisor *
Dates Worked/Served (from/to) *
Reason for Leaving *
May we contact this employer? *
References
Please give the names and phone numbers of two references that are not related to you. *
Are you a Boys & Girls Club Alumni
Note: The Boys & Girls Clubs of North Alabama is an Equal Opportunity Employer and does not discriminate on the basis of race, color, sex, religion, national origin, age, disability, marital status, or liability for service in the Armed Forces of the United States.
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