Application for Employment

Transcription

1 Application for Employment It is the policy of BGCGW that all applicants for employment and all employees are recruited, hired, and assigned on the basis of merit without regard to race, color, religion, sex, national origin, or ancestry, age, marital or veteran status, or disability, or any other legally protected status. Replies to all questions will be held in the strictest confidence. Our organization has adopted core values that guide BGCGW and its staff. The intent is to have every employee live these values and consider them in everything we do. Mission Focus Put kids first! Seek quality versus quantity Be outcome focused Ensure all actions go to furthering the mission (i.e. funding, program quality, work ethics, communication, and assessment/evaluation) Be the leading youth service provider in the communities we serve Character Demonstrate the highest standards of personal/professional conduct, objectivity and trustworthiness Communicate openly, respectfully and with transparency Practice behaviors that ensure an inclusive and respectful workplace Operate and make decisions that are fiscally and ethically responsible Standards Driven/Uniformity Achieve accurate and meaningful targeted outcomes for our stakeholders Strive for and demonstrate a standard of excellence in all aspects of our jobs Work from clearly defined systems, policies, and procedures in all branches, regions and HQ Ensure high quality service across the organization to all stakeholders staff to youth, staff to staff, staff to parents, etc. Solution Driven Exhibit passion Develop solutions, services and resources that meet the unique needs of our customers Be open and willing to look at new and different perspectives take calculated risks and make good decisions Be creative Be fearless!

2 PERSONAL INFORMATION (Please Print) Position Applied For Date Available for Work Date of Application Desired Salary Referral Source: Advertisement Employee Relative/Friend Walk In Employment Agency College Type of Employment Desired: Full Time Part Time Name Address First Middle Last Street City State Zip Code Day Telephone Number Night Telephone Number E mail address If you are under the age of 18 years, can you provide proof of your eligibility to work? Yes No Are you legally eligible for employment in the United States? Yes No (Proof of identity and eligibility will be required upon employment) Have you previously submitted an employment application at BGCGW? No Yes (When ) Have you previously been employed with BGCGW? No Yes (When and where ) Have you previously been employed with another BGC? No Yes (When and where ) Do you have any relatives or friends who work for BGCGW? Yes No If yes, who Are you available to work overtime as needed (weekday or weekend) by BGCGW? Yes No Have you been convicted of a crime in the past ten years that has not been annulled, Yes No expunged or sealed by a court? If yes, please describe in full. Is there anything which would interfere with your regular attendance and punctuality if you Yes No are offered a job with BGCGW? If yes, please explain.

3 EMPLOYMENT HISTORY Start with your last/current position held, including military experience and work back. A resume may be attached to describe your duties and scope of responsibility in each job. Company Employed from to Your Title City/State Name & Title of Immediate Supervisor May we contact Yes No Contact E mail or Phone # Starting Salary or Hourly Rate Final Salary or Hourly Rate Reason for Leaving Company Employed from to Your Title City/State Name & Title of Immediate Supervisor May we contact Yes No Contact E mail or Phone # Starting Salary or Hourly Rate Final Salary or Hourly Rate Reason for Leaving Company Employed from to Your Title City/State Name & Title of Immediate Supervisor May we contact Yes No Contact E mail or Phone # Starting Salary or Hourly Rate Final Salary or Hourly Rate Reason for Leaving

4 EDUCATION Schools Attended Name and Location From To High School Associate s Bachelor s Master s Doctorate Other Did you graduate? Diploma, GED, or Major GPA List professional, trade, business, or civic associations and any offices held. Exclude memberships which would reveal sex, race, religion, national origin or ancestry, age, disability, or other protected status. List any specialized training, skills, certifications or other additional information you feel may be helpful to us in considering your application.

5 REFERENCES Please complete the information below for at least three business/work references who are not related to you and are not previously listed supervisors. If you were a manager, provide at least one subordinate and one peer reference. If not applicable, list three school/personal references not related to you. Providing this information means you give BGCGW permission to contact those individuals listed. Name Title Telephone Number and Years Known PLEASE READ BEFORE SIGNING If you have any questions regarding the following statements, please ask them of a HR Representative before signing this Application. I certify that all of the information given by me on this Application or in supplemental form is true and correct to the best of my knowledge and belief. I further understand that false or misleading statements on this Application or supplemental forms are sufficient cause for my not being hired or my dismissal if I am hired. I understand that should I be employed with BGCGW, I will be required, in accordance with the Immigration Reform and Control Act of 1986 (IRCA), to provide on my first day of employment documents providing proof of my identity and employment eligibility status. I acknowledge that this verification is a condition of employment and that failure to comply will void my offer of employment. I understand that should I be employed by BGCGW, my employment is at will. At will means that either party may end the relationship at any time, with or without notice. There is no promise or guarantee of employment or that my employment will continue for any specific period of time. I understand that in order to achieve uniformity and to comply with BGCGW policy, offers of employment are limited to those contained in written offer letters to prospective employees. I also understand that any verbal discussions of terms or conditions of employment by BGCGW representatives are not binding upon BGCGW unless confirmed in such offer letters. I understand that BGCGW may contact past employers, educational institutions and references for verification of the information listed in this Application and I authorize any such organizations or individuals to provide the requested information. I herby acknowledge that I have read and understand each of the above statements. Date Signature of the applicant The functions of the position for which I am applying have been thoroughly explained to me. I completely understand these functions and I am capable of performing them with or without reasonable accommodation. I herby acknowledge that I have read and understand the above statement. Date Signature of the applicant

6 BGCGW VOLUNTARY AFFIRMATIVE ACTION INFORMATION BGCGW is pursuing an Affirmative Action program to ensure equal employment opportunity in its hiring practices. We are asking you to help us in this effort by completing the information below. Completing this information will assist us in monitoring the effectiveness of our program. Your response is voluntary, shall remain confidential, be kept separately from your Application, and shall in no way affect a decision regarding your employment. Position Applied For Name Last First Middle Birth Date / / Sex Female Male Please check one of the following Ethnic Groups (see descriptions below) HISPANIC/LATINO: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. NON HISPANIC/LATINO: A person NOT of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.. If NON HISPANIC/LATINO, please check one of the following Race Groups (see description below) WHITE (NOT HISPANIC OR LATINO): A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. BLACK OR AFRICAN AMERICAN (NOT HISPANIC OR LATINO): A person having origins in any of the Black racial groups of Africa. NATIVE HAWAIIAN AND OTHER PACIFIC ISLANDER (NOT HISPANIC OR LATINO): A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. ASIAN (NOT HISPANIC OR LATINO): A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. AMERICAN INDIAN OR ALASKAN NATIVE (NOT HISPANIC OR LATINO): A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. TWO OR MORE RACES (NOT HISPANIC OR LATINO): All persons who identify with more than one of the above five races.

7 Special Notice to Vietnam Era Veterans, Disabled Veterans, Other Eligible Veterans, and Individuals with Disabilities: If you wish to be identified, please check any/all that are applicable. VIETNAM ERA VETERAN: A person who (a) served in the military, ground, naval, or air service of the United States on active duty for a period of more than 180 days, and was discharged or released there from with other than a dishonorable discharge, if any part of such active duty occurred (1) in the Republic of Vietnam between February 28, 1961 and May 7, 1975; or (2) between August 5, 1964 and May 7, 1975, in all other cases or (B) was discharged or released from active duty for service connected disability if any part of such active duty was performed (1) in the Republic of Vietnam between February 28, 1961 and May 7, 1975 or (2) between August 5, 1964 and May 7, 1975, in all other cases. SPECIAL DISABLED VETERAN: (a) a veteran who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans Affairs for a disability (i) rated at 30% or more, or (2) rated at 10% or 20% in the case of a veteran who has been determined under Section 3106 of Title 38, U.S.C. to have a serious employment handicap or (b) a person who was discharged or released from active duty because of a service connected disability. OTHER ELIGIBLE VETERAN: Veterans who served in the military, ground, naval, or air service of the United States on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized. To identify the campaigns or expeditions that meet this criterion, see the reverse side of this form. DISABLED INDIVIDUAL: The term disability refers to 1) a physical or mental impairment that substantially limits one or more of the major life activities of such an individual 2) a record of such impairment; or 3) being regarded as having such impairment.