Equal Opportunity Employer
Boys & Girls Clubs of Amarillo (“BGCA”) is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or other protected status.

INSTRUCTIONS: Please print and answer all questions accurately and completely. Submit “N/A” in any space that does not apply to you.
Incomplete applications or applications providing additional non-requested information are considered withdrawn and will not be
considered.

POSITION APPLYING FOR

EDUCATION

PREVIOUS EMPLOYMENT

WORK EXPERIENCE: Please complete all information, beginning with your current or most recent employer. Include periods of unemployment, self-employment and military service
WORK EXPERIENCE: Please complete all information, beginning with your current or most recent employer. Include periods of unemployment, self-employment and military service
WORK EXPERIENCE: Please complete all information, beginning with your current or most recent employer. Include periods of unemployment, self-employment and military service

PERSONAL REFERENCES

Please list three personal references.

QUESTIONNAIRE

IN AN EFFORT TO MAINTAIN CONFIDENTIALITY, THIS PORTION OF THE APPLICATION MAY NOT BE DUPLICATED

BOYS & GIRLS CLUB OF AMARILLO CONSENT FOR CRIMINAL BACKGROUND HISTORY CHECK AUTHORIZATION/WAIVER/INDEMNITY

I hereby give my permission in exchange for good and valuable consideration for the Boys & Girls Clubs of Amarillo to obtain information relating to my criminal history record. I understand that this information will be used, in part, to determine my eligibility for an employment/volunteer position with this organization. I also understand that as long as I remain an employee or volunteer here, the criminal history records check may be repeated at any time. I, the undersigned, do, for myself, my heirs, executors and administrators, hereby remise, release and forever discharge and agree to indemnify and defend the Boys & Girls Clubs of Amarillo and each of their officers, directors, employees, and agents and hold them harmless from and against any and all causes of actions, suits, liabilities, costs, debts and sums of money, claims and demands whatsoever (including claims for the negligence, gross negligence, and/or strict liability of the Boys & Girls Clubs of Amarillo), and any and all related attorneys fees, court costs, and other expenses resulting from the investigation of my background in connection with my application to become a volunteer/staff member. The following is my true and complete legal name and all information is true and correct to the best of my knowledge:
I authorize BOYS & GIRLS CLUBS OF AMARILLO (BGCA) to investigate all statements in this application and to secure any necessary information from all my employers, references and academic institutions. I hereby release all those employers, my employment history, my academic credentials or qualifications, and my suitability for employment with BGCA. I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning my academic credentials and employment references. I further understand that any false or misleading statements will be sufficient cause for rejection of my application if BGCA has not employed me or immediate dismissal if BGCA has employed me. I also authorize BGCA to supply information about my employment record, in whole or in part, in confidence to any prospective employer, government agency, or other party having a legal and proper interest and I hereby release BGCA form any and all liability for its providing this information. I understand that nothing in this employment application in BGCA’s policy statements or personnel guidelines, or in my communications with my BGCA official is intended to create an employment contract between BGCA and me. I also understand that BGCA has the right to modify its policies without giving me any notice of the changes. No promises regarding employment have been made to me. I understand that if an employment relationship is established, I have the right to terminate my employment at any time for any reason. I also understand that BGCA retains the right to terminate my employment at any time for any reason. I hereby acknowledge that I have read and understand the preceding statements.