Background Verification and Authorization
Only Human Resources sees the information below-it is not available to hiring supervisors or others in the organization. If you are not selected for the position this form is shredded and not retained in our files. *Information is required for identification purposes only and is in no manner used as qualifications for employment.
Email address *
Name: *
Your answer
Maiden or Alias Name
Your answer
Social Security Number: *
Your answer
*Date of Birth: *
Gender Identity (Optional)
The Boys and Girls Clubs of Northwest Colorado does not discriminate on the basis of sexual orientation, gender identity or expression. In order to track effectiveness of our recruiting efforts and ensure we consider the needs of all our employees, please consider writing in your gender.
Your answer
*Race (Optional)
Your answer
Please list addresses and dates over past 7 yrs.
Your answer
By checking the box below I hereby authorize the Boys and Girls Clubs of Northwest Colorado to make an independent investigation of my background, references, character, past employment, education, 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. *
I release Boys & Girls Clubs of Northwest Colorado and any person or entity which provides information pursuant to this authorization, from any and all liabilities, claims, or law suits in regard to the information obtained from any and all of the able referenced sources. *
I understand that any offer of employment is contingent on a satisfactory background investigation. I also understand that this form will be kept in my permanent file if I am employed. I certify that the following is true and complete legal name and all information herein and correct to the best of my knowledge: *
Printed Name-Typing your name will be used as your digital signature
Your answer
Parent Name -Typing your name will be used as your digital signature
Your answer
Parent Consent to Background check of minor:
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