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 *
First Name: *
Middle Name: *
Last Name: *
Maiden or Alias Name
Social Security Number: *
Date of Birth: *For identification purposes Only, and is in no manner a qualification for employment *
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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.
Race (Optional)
Please list addresses and dates over past 7 yrs.
Please list addresses and dates over past 7 yrs.
Please list addresses and dates over past 7 yrs.
Please list addresses and dates over past 7 yrs.
By checking the box below, you hereby authorize Boys & 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. By signing below, you acknowledge receipt of Background Verification Authorization and certify that you have read this disclosure. Furthermore, you authorize the obtaining of investigative consumer reports at any time after receipt of this authorization and throughout the course of your employment, if applicable. The scope of the Background Verification Authorization and your authorization is not limited to the present and, if you are hired, will continue throughout the course of your employment and allow us to conduct future screenings for retention, promotion or reassignment, as permitted by law and unless revoked by you in writing. 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 contained herein is true and correct to the best of my knowledge. *
Printed Name-Typing your name will be used as your digital signature
Parent Name -Typing your name will be used as your digital signature
Parent Consent to Background check of minor:
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