Name: Summer Benefit 2019
Start: 2019-08-01T17:30:00-05:00
End: 2019-08-01T20:30:00-05:00
Location: River’s Edge Convention Center

Personal Information
Name*
First Middle Last
Current Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Work Phone
Email*
How did you hear about us?
Other*
Type of Experience Desired
Other*
Site(s) you are interested in volunteering/interning at
- Clearview
- Discovery
- Eastside
- Kennedy
- Lincoln
- Madison
- Mississippi Heights
- Oak Hill
- Oak Ridge
- Pine Meadow
- Pleasantview
- ROCORI
- Roosevelt
- Southside
- Stride Academy
- Talahi
- Westwood

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Background Check
*Please note: This document does not count as the applicant’s background check consent form. The consent form will be filled out upon completion of the screening.

Criminal background checks at a cost of $13.00 will be processed after the applicant is screened and completes a background check consent form. This cost is the responsibility of the applicant. Please provide your credit card information below, and accounting will hold processing until you are notified of acceptance. If the application process is terminated before screening for any reason, this transaction will also be terminated and your credit card will not be charged.

If credit card processing is not an option for you, please contact our Volunteer/Internship Coordinator for other options at 320-252-7616.
Background Check
Price: $13.00
Credit Card Information
Total
$0.00
Billing Address*
Street Address Address Line 2 City State ZIP Code
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

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Education
High School
Name & Location of School*
Number of Years Completed*
Vocational/Technical College
Name & Location of School
Number of Years Completed
- Not Applicable
College
Name & Location of School
Number of Years Completed
- Not Applicable
Times Available to Report to Work
Monday
Tuesday
Wednesday
Thursday
Friday

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Employment
Please give accurate, complete full-time and part-time employment record. Start with present or most recent employer. Do not write "see resume."
May we contact the employer's listed below?*
Company 1
Name
Address
Street Address Address Line 2 City State ZIP Code
Title
Employed From
Employed To
Salary From
Salary To
Duties
Reason for Leaving
Name(s) of Supervisor
Telephone
Company 2
Name
Address
Street Address Address Line 2 City State ZIP Code
Title
Employed From
Employed To
Salary From
Salary To
Duties
Reason for Leaving
Name(s) of Supervisor
Telephone

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Volunteer Experience
Company 1
Name
Address
Street Address Address Line 2 City State ZIP Code
Volunteered From
Volunteered To
Duties
Reason for Leaving
Name(s) of Supervisor
Telephone
Company 2
Name
Address
Street Address Address Line 2 City State ZIP Code
Volunteered From
Volunteered To
Duties
Reason for Leaving
Name(s) of Supervisor
Telephone

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Personal References
List two references. (Exclude previous supervisors and relatives.)
Reference*
Name Home Phone Work Phone

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Terms and Agreements
The Boys & Girls Clubs of Central Minnesota is a part of a nationwide and local effort to help assure the protection of children from abuse and exploitation. Therefore, to safeguard the well being of the youth served, the Boys & Girls Club will investigate the accuracy of information provided in the application process for all applicants before appointment to the staff can be made. This investigation may include, but is not limited to, reference checking with past employers, the military, schools, appropriate volunteer agencies, police departments and other government agencies.

The Boys & Girls Club is an equal opportunity employer (EOE). We are dedicated to a policy of nondiscrimination in employment on any basis, including race, color, creed, religion, national origin, sex, age, marital status, disability, protected veteran status, sexual orientation or status as regard to public assistance.

Applications remain on file for 12 months.

Conditions of Employment: All employees of the Boys & Girls Clubs of Central Minnesota are “at will” employees. As such, they are retained at the discretion of the Executive Director and Executive Committee of the Board of Directors. The Boys & Girls Club retains sole discretion to make determinations of appropriate action to be taken in response to inappropriate, improper, or illegal employee conduct. The Executive Director and Executive Committee shall retain sole discretion to determine the definition of inappropriate or improper conduct. Additional policies may be added from time to time as necessary, without prior notice, at the discretion of the Executive Director or the Executive Committee of the Board of Directors.

Applicant’s Statement of Agreement

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge and agree that falsification or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

I authorize persons, schools, current and previous employers and organizations named in this application (and accompanying resume, if any) to provide the Boys & Girls Club with relevant information that may be required to arrive at an employment decision.
*
- I understand and agree to the Terms and Agreements.
Phone
This field is for validation purposes and should be left unchanged.

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Volunteer/Internship Application

Step 1 of 7

Personal Information

Background Check

Credit Card Information

Education

High School

Vocational/Technical College

College

Times Available to Report to Work

Employment

Company 1

Company 2

Volunteer Experience

Company 1

Company 2

Personal References

Terms and Agreements

Applicant’s Statement of Agreement

Name	Home Phone	Work Phone