Girl Scouts of Western Ohio

Administrative Office

4930 Cornell Road, Cincinnati, OH 45242

513-489-1025, 1-800-537-6241  FAX: 513-489-1417

 

EMPLOYMENT APPLICATION

 

Girl Scouts of Western Ohio is an equal opportunity employer.  All applications for employment will be considered without regard to race, religion, color, sex, age, national origin, citizenship, disability, marital status, or any other classification protected by applicable law.

* indicates items that must be completed in order to submit your application
PERSONAL DATA
  Last Name*   First Name*   Middle Initial*   Social Security # *
  Present Address*    Present Telephone # *
  City*                          State*                                 Zip Code*
  Permanent Address*   Permanent Telephone #*
  Permanent City*             Permanent State*                 Permanent  Zip Code*
  Cell phone #                                                     E-mail address
POSITION DESIRED
  Position/Type of Work Desired* Date Available* Salary Desired*
  Select type of work desired 
  Source of referral:
           Own initiative      School/Organization
           Employee (name)      Other
           Publication/Web site (name)
  Were you ever employed by GSUSA or a Girl Scout Council?       Where? When?
 
EMPLOYMENT HISTORY - List all employers for whom you have worked in the last ten years.  If you need additional space click the link on the confirmation page that will appear after you submit this form.
Present or Last Employer
  Name of Employer*      Title or Position*
  Address*   City* State* Zip Code* Phone #*
  Employment Dates (Month & Year):  From*  - To*  
  Starting Salary* per      Final Salary* per   Other compensation
  Name and Title of Immediate Supervisor* Reason for Leaving*
  Description of Duties*
   
Previous Employers
1. Name of Employer      Title or Position
  Address   City State Zip Code Phone #
  Employment Dates (Month & Year):  From   - To  
  Starting Salary per      Final Salary per   Other compensation
  Name and Title of Immediate Supervisor Reason for Leaving
  Description of Duties
   
2. Name of Employer      Title or Position
  Address   City State Zip Code Phone #
  Employment Dates (Month & Year):  From   - To  
  Starting Salary per      Final Salary per   Other compensation
  Name and Title of Immediate Supervisor Reason for Leaving
  Description of Duties
   
3. Name of Employer      Title or Position
  Address   City State Zip Code Phone #
  Employment Dates (Month & Year):  From   - To  
  Starting Salary per      Final Salary per   Other compensation
  Name and Title of Immediate Supervisor Reason for Leaving
  Description of Duties
Type "X" if you have additional employers in the space below.
I have additional employers and will submit this additional information via e-mail.
 
EDUCATION
  High School or GED* Undergraduate College/University Graduate/Professional Business/Technical School
School Name and Location *
Check last year completed  

 
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

 * You are not required to supply information that would reveal your race, religion, color, sex, age, national origin, citizenship, disability, marital status, or any other classification protected by applicable law.     

TECHNOLOGICAL SKILLS - Indicate your level of proficiency

 

Check experience level
Word
Access
Excel
Outlook
PowerPoint
Other

PROFESSIONAL DEVELOPMENT TRAINING

Name of Course, Seminar, etc. Course Content Number of Hours Dates

VOLUNTEER ACTIVITIES 

You need not list organizations whose name or nature indicates your race, religion, color, sex, age, national origin, citizenship, disability, marital status, or any other classification protected by applicable law.

Organization Position/Offices Held Describe Responsibilities and Services Number of Years

STATEMENT

Briefly explain why you are interested in working for Girl Scouts - Great Rivers Council, Inc.*

REFERENCES*

Applicant must list four(4) persons, other than relatives, who know of your qualifications and/or background experience who can give an honest accounting of the type of person you are.  All information related to references must be current and accurate.

Name Profession Area Code & Telephone No. Business or Home Address
Business

Home     

Business

Home     

Business

Home     

Business

Home     

Please indicate whether schooling or employment was under another name:

Have you ever been convicted or pled no contest or guilty to a crime (other than minor traffic violations)?*       Please type "Yes" or "No"

If yes, please state offense, date and location (a conviction record will not necessarily be cause for disqualification).

Note:  This is only applicable if the job you are applying for requires driving.  Employees hired for jobs that require driving will be required to have a driver's record check.

Do you have a valid driver's license?  Yes    No

 

Have you had your driver's license suspended or revoked in the last four years?*  Yes    No

If yes, give details:

 

APPLICANT'S CERTIFICATION

Girl Scouts of Western Ohio requests the following information because of our dedication and commitment to the girls we serve.  All youth-serving organizations must take reasonable precautions when hiring paid staff who work directly with children.  This information is confidential.

I certify that I never have been convicted of, nor pled no contest, or guilty to the following:

  • Child abuse in violation of Ohio Revised Code Section 2919.22
  • Endangering children in violation of section 2907.04
  • Gross sexual imposition in violation of section 2907.05
  • Sexual imposition in violation of section 2907.06
  • Importuning in violation of section 2907.07
  • Voyeurism in violation of section 2907.08
  • Public indecency in violation of section 2907.09
  • Any offense of violence, or any existing or former offense of any municipal corporation , this state, any other state or the United States that is similar to any of the above offenses.

I agree with the above statements. *         Yes     No

I certify that all information  is 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.

I understand that employment is conditioned upon acceptable results of a pre-employment screening and successful completion of a background check.

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 at any time, with or without cause or notice, and may be terminated by the council at any time with or without cause or notice.  I understand that any oral or written statements to the contrary are hereby expressly disavowed and are not to be relied upon by any prospective or existing employee.

I authorize Girl Scouts of Western Ohio to inquire into my employment history and qualifications for the position(s) for which I am being considered.  I authorize past/current employers and other persons to release the information requested by Girl Scouts of Western Ohio. I hereby waive any and all claims against any person who provides information in response to Girl Scouts of Western Ohio's request concerning my employment history and other qualifications.

I have read, understand and consent to the above statements.   *         Yes     No

I understand this is my electronic signature:*

Signature:    Date:

VOLUNTARY SELF-IDENTIFICATION

 

Various agencies of the United States Government require employers to maintain information on applicants pertaining to factors such as race, sex, and type of position for which an individual applies.  The information requested on this sheet is for compliance with certain record keeping requirements. Girl Scouts of Western Ohio believes all persons are entitled to equal employment opportunities and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation or any other classification protected by Federal, state, or local law.

 

Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment. Identification can be declared at any time. This information will be kept separate from your personnel records. It will remain separate from your employment application and will not be used in any way during the interviewing or hiring process.

 

First Name: Middle Initial: Last Name:

Date: Social Security #:

Position Applied For:

Sex:                       Region:

Race/Ethnic Data (Read the descriptions, then select from the drop down box the corresponding ethnic group with which you most identify)

 

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

 

White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

 

Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.

 

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

 

Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

 

American Indian or Alaskan Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South American (including Central America), and who maintain tribal affiliation or community attachment.

 

Two or More Races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.