Site(S) You Are Interested in Volunteering/Interning At

VOLUNTEER APPLICATION

Personal Information

Print Name (Last) (First) (Middle) / Current Date
Address / Home Phone
City, State, ZIP / Cell Phone
E-mail address: ______
How did you find us?
Referral Source: Walk-in Club Employee Friend/Relative Club Member Internet
Other: ______
Typ of experience desired:
Volunteer Internship/Practicum High School Requirement Jr. Volunteer (grades 7-12)
Other: ______
Have you ever been convicted of a criminal offense? (An affirmative answer will not necessarily disqualify you from being hired.)
Yes No If yes, please explain.
Times Available to Report to Work:
Monday:______Tuesday:______Wednesday:______
Thursday:______Friday:______

Site(s) you are interested in volunteering/interning at

__ Clearview__Madison__Pine Meadow__Westwood

__Discovery__Mississippi Hts.__Pleasantview__Roosevelt B&GC

__Kennedy__Oak Hill__ROCORI__Eastside B&GC

__Lincoln__Oak Ridge__Talahi__Southside B&GC

Education

School / Name & Location of School / Number of Years Completed
High School
Vocational/Technical College
College

Employment History 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 employers listed below? If not, which employer? ______

Reason:______

1 Company Name / Employed (month & year)
From To
Address City State Zip / Salary
From To
Job Title / Reason for Leaving
Duties
Name of Supervisor Telephone
( )
2 Company Name / Employed (month & year)
From To
Address / Salary
From To
Job Title / Reason for Leaving
Duties
Name of Supervisor Telephone
( )

Volunteer Experience

Company Name Telephone / Volunteered (month & Year)
From To
Address / Name of Supervisor
Job Title / Reason for Leaving
Duties
Company Name Telephone / Volunteered (month & Year)
From To
Address / Name of Supervisor
Job Title / Reason for Leaving
Duties

Personal References

List two references (Exclude previous supervisors and relatives)
1.______Telephone: (Home)______(Work)______
2.______Telephone: (Home)______(Work)______

General

Please include any other information you think would be helpful to us in considering you for employment, such as

activities, accomplishments, other skills and abilities, etc. (Please exclude all information indicative of race, color,

religion, national origin, sex, physical or mental disability, protected veteran status or sexual orientation.

______

Driver’s License Number (if you have one): ______

Is there anything that would prohibit you from doing the job for which you are applying? _____Yes _____No

If yes please explain:______

______

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 definitions 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 falsified information 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.

______

SignatureDate