Employment Application

List additional item(s) that you would like to tell us about yourself (hobbies, interests, activities, etc.)(Required)

Criminal Background Screening

A Criminal Background Screening which includes; a basic search of the (1) National Criminal File; (2) the Social Security Number Check; and (3) the Sexual Offender Registry is requested on the following individual who has indicated a desire to participate as a volunteer and / or employee for the Boys and Girls Club of Decatur. This program requires that a background check be made to try to provide for the most positive influence upon our youth.

Home Phone(Required)

Work Phone(Required)

Date of Birth(Required)

Place of Birth(Required)

I hereby authorize the Boys and Girls Club of Decatur, Inc. to utilize any reporting agency to release any and all information requested for the purpose of a criminal background screening; and I hereby release, acquit, and agree to hold harmless from any and all resulting liability and covenant not to sue any reporting agencies in connection with releasing such information to the Boys and Girls Club of Decatur, Inc.