Employment Form

Provide two references (non family members)

Please select the applicable response

By typing my name below, I certify that all the answers on the application and any attachments are true and complete to the best of my knowledge. I also certify that I have not withheld any pertinent information.


I agree that in the course of considering my application you may inquire to verify information considering my background. I specifically authorize you to investigate all statements in this application. I authorize educational institutions, employers and references listed above to give you any and all information concerning education, employment and fitness to work with children and young people. I also agree to release the Boys & Girls Clubs of the Corridor, the listed institutions and references, and any law enforcement agencies from any liability or claims resulting from the release of this information.