Please indicate whether schooling or employment was under another name:
Applicants without recent employment experience list persons, other than relatives, who know of your qualifications and/or background experience.
Area Code/Telephone Number
I hereby authorize you to check all my educational references and the personal employment references as indicated below; I further authorize these references to
release to you all information that they have about me (check all that apply):
Present employer Present employer after accepting position
Previous employers Additional references listed
Do you know of any reason why you would not be able to perform the essential functions of the job
position for which you are applying with or without reasonable accommodation? Yes No Please describe
Are you legally eligible to be employed in the United States? Yes No (Proof of identity and eligibility will be required upon employment.)
Have you ever been convicted of a crime (other than traffic violations)? Yes No
If yes, please state offense, date and location (a conviction record will not necessarily be cause for disqualification).
Are you available to work: Full-time Days Nights Weekends ? If you cannot work full-time, please explain.
Any limitations on overtime? Yes No . If you cannot work overtime, please explain.
I understand that this employment application and any other Girl Scout documents are not contracts of employment, and that any individual who
is hired may voluntarily leave employment upon proper notice and may be terminated by the council at any time. I understand that any oral or
written statements to the contrary are hereby expressly disavowed and should not be relied upon by any prospective or existing employee. I also
understand that I am submitting this application to become an employee of Girl Scouts of Eastern Oklahoma Girl Scout Council and not GSUSA.
I certify that my answers to the preceding questions are true and complete and that I have not knowingly withheld any information which might, if
disclosed, affect my application unfavorably. I understand that any misrepresentation or omission of facts on this application will be cause for
rejection of this application or dismissal after employment and that employment is subject to verification of references.
An Equal Opportunity Employer M/FN/H Form No. 4132-FM1 Girl Scouts of the U.S.A. Revised March 2007
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