Position
Regular
Full Time
Seasonal
Part Time
Date Available
Salary Desired
Source of referral:
Agency (name)
Own Initiative
Publication (name)
Employee (name)
School/Organization
Other
Application for Employment
in
Girl Scouts of Eastern
Oklahoma
Check One:
New Applicant
Transfer Applicant
Reemployment Applicant 
This council is an equal opportunity employer. All applications for employment will be considered without regard to race, religion, color,
sex, age, national origin or ancestry, citizenship, disability, marital status, or veteran status.
Conditions of employment are stated at the end of this form. Please read carefully before you sign this application. (Application must be
completed in full even if attaching resume.)
This application form will be considered current for 90 days only. At the end of this period, if you are still interested in employment, it will be
necessary for you to reapply by completing a new application form.
Personal Data
Last Name First Name Middle Name or Initial
Date of Application
Present Address (Number and Street)
City
State
Zip Code
Area Code/Telephone No.
Permanent Address (if different from above)
City
State
Zip Code
Cell/Mobile Telephone No.
Position Desired
Willing to travel?
Yes
No
Percentage of time:
Willing to relocate?
Yes No
Geographic Preference
Do you have relatives employed by
GSUSA or a Girl Scout Council?
Yes No
Were you ever employed by GSUSA or a Girl Scout Council?
Yes No
When? Where?
Have you previously applied to GSUSA or a Girl Scout Council?
Yes No
When? Where?
Employment History
Present or Last Employer
Name of Employer
Title or Position
Address
City
State
Zip Code
Area Code/Telephone No.
Employment Dates (Month and Year)
From: To:
Starting Salary
$ Per
Final Salary
$ Per
Other Compensation
Name and Title of Immediate Supervisor
Reason for Leaving
Description of Duties
Previous Employer
Name of Employer
Title or Position
Address
City
State
Zip Code
Area Code/Telephone No.
Employment Dates (Month and Year)
From: To:
Starting Salary
$ Per
Final Salary
$ Per
Other Compensation
Name and Title of Immediate Supervisor
Reason for Leaving
Description of Duties
Yr
Yr
Yr
Yr
Previous Employer
Name of Employer
Title or Position
Address
City
State
Zip Code
Area Code/Telephone No.
Employment Dates (Month and Year)
From: To:
Starting Salary
$ Per
Final Salary
$ Per
Other Compensation
Name and Title of Immediate Supervisor
Reason for Leaving
Description of Duties
Previous Employer
Name of Employer
Title or Position
Address
City
State
Zip Code
Area Code/Telephone No.
Employment Dates (Month and Year)
From: To:
Starting Salary
$ Per
Final Salary
$ Per
Other Compensation
Name and Title of Immediate Supervisor
Reason for Leaving
Description of Duties
Education
High School or General
Equivalency Diploma (GED)
Undergraduate
College/University
Graduate/
Professional
Business/
Technical
School Name and Location
Last Year Completed
1 2 3 4 1 2 3 4
Diploma / Degree / Credits
Describe Course of Study
Describe any specialized
training, apprenticeship,
skills, and extra-curricular
activities
Describe any honors you
have received
State any additional
information you feel may be
helpful to us in considering
your application
Yr
Yr
Yr
Other Special Knowledge, Skills or Qualifications
Typing Yes No WPM 10-Key Calculator Yes No Personal Computer Yes No
Are you familiar with business software:
Word Yes No Spreadsheets Yes No Database Yes No
E-mail Yes No Presentations Yes No Desktop Publishing Yes No
Rate Your Computer Skills Good Fair Learning Other
Training
Sponsoring Organization and Location
Name of Course, Seminar, etc.
CEUs
Number of Hours
Dates
Volunteer Activities
(You need not list organizations whose name or nature indicates your race, sex, national origin, age, or religion.)
Organization
Position/Offices Held
Describe Responsibilities and Services
Number of Years
Statement
Explain briefly why you are interested in working for our organization:
References
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.
Name
Profession
Area Code/Telephone Number
Business or Home Address
B ( )
H ( )
B ( )
H ( )
B ( )
H ( )
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.
Signature Date
An Equal Opportunity Employer M/FN/H Form No. 4132-FM1 Girl Scouts of the U.S.A. Revised March 2007
click to sign
signature
click to edit
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