TELEPHONE NUMBER: *
CELL PHONE NUMBER: *
EMAIL *
OTHER NAMES USED *
HOW WERE YOU REFERRED TO BOYS & GIRLS CLUBS OF AMARILLO (BGCA)? *
PREVIOUS EMPLOYMENT WITH BGCA (If any, give dates, position, location) *
RELATIVES EMPLOYED BY BGCA (If any. give dates, positions) *
If the answer to either question is yes, please explain (state, date, court, type of crime, place of occurrence, disposition): Note: Conviction of a crime will not necessarily disqualify you for employment Each conviction will be judged on its own merit with respect to time and job relatedness. *
If so, explain: *
POSITION APPLIED FOR * SITE COORDINATOR PROGRAM SPECIALIST BUS DRIVER PROGRAM ASSISTANT OTHER
SALARY REQUIREMENTS (minimum or range) *
WILLINGNESS TO TRAVEL? (Approximate percentage if position indicates) *
NAME AND LOCATION OF HIGH SCHOOL ATTENDED: *
DATES ATTENDED *
NAME AND LOCATION OF COLLEGE OR UNIVERSITY ATTENDED: *
DATES ATTENDED *
DEGREE RECEIVED *
NAME AND LOCATION OF OTHER SCHOOLS ATTENDED: (Graduate, technical, business, military, etc.) *
DATES ATTENDED *
DEGREE RECEIVED *
Professional Licenses: *
List computer or technical skills: *
COMPANY NAME: *
YOUR TITLE *
STARTING BASE SALARY: *
LAST BASE SALARY: *
IF YES, AMOUNT: *
SUPERVISORS NAME: *
SUPERVISORS TITLE: *
TELEPHONE NUMBER OF SUPERVISOR: *
BRIEF DESCRIPTION OF DUTIES & RESPONSIBILITIES: *
REASON FOR LEAVING: *
YOUR TITLE: *
STARTING BASE SALARY: *
LAST BASE SALARY: *
IF YES, AMOUNT: *
SUPERVISORS NAME: *
SUPERVISORS TITLE: *
TELEPHONE NUMBER OF SUPERVISOR: *
BRIEF DESCRIPTION OF DUTIES & RESPONSIBILITIES: *
REASON FOR LEAVING: *
YOUR TITLE: *
STARTING BASE SALARY: *
LAST BASE SALARY: *
IF YES, AMOUNT: *
SUPERVISORS NAME: *
SUPERVISORS TITLE: *
TELEPHONE NUMBER OF SUPERVISOR: *
BRIEF DESCRIPTION OF DUTIES & RESPONSIBILITIES: *
REASON FOR LEAVING: *
Can you perform this job (as detailed verbally or in the job description) with or without reasonable accommodation? *
RELATIONSHIP: *
Phone *
EMAIL ADDRESS:
RELATIONSHIP: *
Phone *
EMAIL ADDRESS:
RELATIONSHIP: *
PHONE NUMBER:
EMAIL ADDRESS:
Explain any ‘YES’ answers in full *
Maiden Names or Other Names Used *
For How Long? *
For How Long? *
Social Security Number *
Drivers License Number *
State of Drivers License *