To Applicant: We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in the position that best meets your qualifications and may assist us in possible future openings.

Answer each question clearly and completely. If more space is required, use separate sheets of paper. All applicants will receive consideration without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or disability.

How did you hear about this job? NewspaperRadioWebsiteFriendCampus RecruitmentCurrent EmployeeWalk inEmployment AgencyRelativeOther

Work Desired: Full-timePart-timeSummer

On what date would you be available to work?

What hours are you available to work? 1st 2nd 3rd

Are you legally eligible for employment in the United States? Yes No

Do you possess a valid driver’s license?

If different than on resume submitted:

Please start with your present or last employer. Military service and relevant volunteer activities can be included. Exclude organization names which indicate race, color, religion, sex, or national origin.

Complete if different than resume submitted.

Please answer if applicable to the position for which you are applying.

Office skills:

Computer skills:

Computer skills: AdvancedAverageLittleNone

Have you ever been confirmed and placed on a child or dependent adult registry? If Yes, you cannot be employed without proof of exspungement. Yes No

Are you over the age of 18? (If under18, hire is subject to verification of minimum legal age.) Yes No

If hired, are you willing to submit to and pass a controlled substance test? Yes No

If you answered yes to question 3, you can not be considered for employment without proof of exspungement from the registry or yes to question 4 will need a variance from the state.

I declare that the statements in this application are true and accurate. I understand that my employment is subject to the results of a physical examination, tuberculosis (TB) screening and satisfactorily meeting the requirements of child abuse and criminal record background checks.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not, nor is it intended to be, a contract of employment.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also that I am required to abide by all rules and regulations of Boys and Girls Home and Family Services, Inc. and its subsidiaries.

I hereby give Boys and Girls Home and Family Services, Inc. and its subsidiaries permission to obtain references regarding my abilities and qualifications for employment, background checks and release reference sources from liability concerning information on reference.

If I am employed, I understand that my employment is “at will” and for an indefinite duration that can be terminated with or without cause and with or without notice at any time either by Boys and Girls Home and Family Services, Inc. and its subsidiaries or by me. I further understand that my employment is at will regardless of any statement made by a Boys and Girls Home and Family Services, Inc. and its Subsidiaries supervisor or other official or agent or in a Boys and Girls Home and Family Services, Inc. and its Subsidiaries policy, practice, handbook, program, or any other written or oral materials. I understand that no representatives other than the President and CEO or the Vice President of Human Resources of Boys and Girls Home and Family Services, Inc. and its subsidiaries have the authority to make agreements with me concerning the length of my employment. Such agreements must be in writing and signed by either the President and CEO or the Vice President of Human Resources and me.

Signature:

Government agencies require periodic reports on the sex, ethnicity, disability and veteran status of applicants. This data is for analysis and affirmative action only. Submission of information about a disability is voluntary.

Gender: ---- Female Male

Race: ---- American Indian or Alaska Native (Not Hispanic or Latino) Asian (Not Hispanic or Latino) Hispanic or Latino Black or African American (Not Hispanic or Latino) White (Not Hispanic or Latino) Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) Two or More Races (Not Hispanic or Latino)

Veteran Status: ---- No Eligible Veteran Disabled Veteran Eligible and Disabled Veteran