Boys & Girls Club of Watertown SD

Applicant Information

Date: 5/19/2012

Last Name:

First Name:

M.I.

Address:

Apt:

City:

State:

Zip:

Phone:

Email:

Date Avail.:

Desired Salary:

SSN:

Applying For:

Are you a citizen of the United States:

If No, Are you authorized to Work in the U.S.?

Have You Ever Worked For This Company

If Yes, WHEN?

Have You Ever Been Convicted of A Felony

If Yes, Explain

How Did You Hear About Us:

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Do you have a current and valid driver's license?

Has it ever been revoked, suspended, or denied?

If Yes, Explain

EDUCATION
High School:	Address:
From: To:	Did you Graduate?:	Degree:

College:	Address:
From: To:	Did you Graduate?:	Degree:

Other:	Address:
From: To:	Did you Graduate?:	Degree:

REFERENCES
Please List Three Personal References
Full Name:		Relationship:
Company:		Phone:

Full Name:		Relationship:
Company:		Phone:

Full Name:		Relationship:
Company:		Phone:

Previous Employment

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From: To:

Resason For Leaving:

May We Contact Your Current Employer?:

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From: To:

Resason For Leaving:

May We Contact Your Current Employer?:

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From: To:

Resason For Leaving:

May We Contact Your Current Employer?:

Military Service
Branch		From: To:
Rank At Discharge:		Type of Discharge:
If other thank Honorable, Please Explain:

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