EmailMeForm
Online Application
Instructions: Please enter your information. Answer all questions.
Personal Information
Full Given Name
*
First, Middle, Last, Suffix
Address:
*
Street Address
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
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Bhutan
Brunei Darussalam
Myanmar
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China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Date of Birth:
*
MM
/
DD
/
YYYY
Phone Number:
*
###
-
###
-
####
Personal Email:
Have you been known by any other name?
*
Yes
No
If yes, what is the name?
First date known by this name:
MM
/
DD
/
YYYY
Last date known by this name:
MM
/
DD
/
YYYY
Have you ever been convicted of a felony?
*
Yes
No
If yes, describe in full
Are you a citizen of the United States?
*
Yes
No
If not, give Alien Registration Number?
Are you over the age of 18 ?
*
Yes
No
If no, do you have a work permit?
Yes
No
Referral Source:
*
Advertisement
Website
Relative
Employment Agency
Other
Do any of your friends or relatives work here?
*
Yes
No
If yes, list names:
Have you filed an application here before?
*
Yes
No
If yes, provide date:
Date:
MM
/
DD
/
YYYY
Have you ever been employed here before?
*
Yes
No
If yes, provide date:
Date:
MM
/
DD
/
YYYY
POSITION/AVAILABILITY:
Position Applied For
*
Status Desired:
*
Full-time
Part-time
Other (Temporary/Seasonal)
What date are you available to start work?
*
MM
/
DD
/
YYYY
Are you presently a member of the Military Reserve of National Guard?
*
Yes
No
List any skills, qualifications, courses or training you have that relate to the position for which you are applying:
List Profesional, Trade, Business or Civic activities and offices held. (Exclude groups which indicate race, color, religion, sex or national origin):
EMPLOYMENT HISTORY:
Present Or Last Position:
Employer:
*
Address:
*
Supervisor:
*
Phone Number
*
###
-
###
-
####
Email
Position Title:
*
Start Date
*
MM
/
DD
/
YYYY
End Date
*
MM
/
DD
/
YYYY
Responsibilities
*
Reason for Leaving:
*
Starting Salary
*
Input hourly wage, if not salaried.
Ending Salary
*
Input hourly wage, if not salaried.
Previous Position
Employer:
*
Address:
*
Supervisor:
*
Phone Number
*
###
-
###
-
####
Email
Position Title:
*
Start Date
*
MM
/
DD
/
YYYY
End Date
*
MM
/
DD
/
YYYY
Responsibilities:
*
Reason for Leaving:
*
Starting Salary
*
Input hourly wage, if not salaried.
Ending Salary
*
Input hourly wage, if not salaried.
Previous Position
Employer:
Address:
Supervisor:
Phone Number
###
-
###
-
####
Email
Position Title:
Start Date
MM
/
DD
/
YYYY
End Date
MM
/
DD
/
YYYY
Responsibilities:
Reason for Leaving:
Starting Salary
Input hourly wage, if not salaried.
Ending Salary
Input hourly wage, if not salaried.
May We Contact The Employers Listed Above?
*
Yes
No
If not, indicate the employer(s) you do not wish us to contact and state the reason why not:
Have you ever been bonded?
*
Yes
No
If yes, where have you been bonded?
Summarize special skills and qualifications acquired from employment or other experience:
What office or business machines have you operated?
If applying for, or willing to accept a clerical position: what is your typing speed?
Do you take shorthand?
Yes
No
if so, what is your speed?
References:
Name/Title Address Phone
*
*
*
HEALTH HISTORY:
If required for the position for which you are applying, will you consent to periodic physical examinations and blood or urine analysis at company expense? (Note: This analysis may test for controlled substances)
*
Yes
No
Do you have any physical, mental or medical impairment or disability that would limit your job performance for the position for which you are applying?
*
Yes
No
If yes, please explain:
When is the last time you missed a week of work or school due to illness or injury?
*
If you have, what was the nature of the illness or injury
How much time have you lost from work or school through illness or injury in the past two (2) years?
*
If any time was lost, what was the nature of the illness or injury?
Names and Addresses of Doctors:
May we contact them?
*
Yes
No
When was the last time you missed a week of work or school for a reason other than illness or injury?
*
If you have missed a week of work, what was the reason?
Are you available to work:
*
Full-time
Part-time
Shift work
Overtime
If there are any hours you are unwilling to work, what are they?
Are you on lay-off and subject to recall?
*
Yes
No
Can you travel is a job requires it?
*
Yes
No
DRIVING RECORD:
Complete this section only if you are applying for a position which requires the operation of a motor vehicle.
Do you presently have a valid driver's license?
Yes
No
if yes, fill in the following information:
State:
Number:
Type:
Expiration Date:
MM
/
DD
/
YYYY
Have you had a driving violation within the past five (5) years?
Yes
No
If yes, describe:
RECORD OF EDUCATION:
Name and Address Of High School
*
Course of Study:
List Diploma or Degree:
Select last year completed:
1st
2nd
3rd
4th
Did you graduate?
Yes
No
Yes/GED
College
Most Recent
Name and Address Of College
List Diploma or Degree:
Other (Specify):
Select last year completed:
1st
2nd
3rd
4th
Did you graduate?
Yes
No
College
Previous
Name and Address Of College
List Diploma or Degree:
Other (Specify):
Select last year completed:
1st
2nd
3rd
4th
Did you graduate?
Yes
No
College
Previous
Name and Address Of College
List Diploma or Degree:
Other (Specify):
Select last year completed:
1st
2nd
3rd
4th
Did you graduate?
Yes
No
Describe Specialized Training, Apprenticeship, Skills and Extracurricular Activities:
*
Are you a veteran of the U.S. Military Service?
*
Yes
No
if yes, what branch of U.S. Military Service?
What referred you to fill out an application for the Boys and Girls Ranches of Alabama?
*
Please select
Ranch Website
Online Ad
Word of Mouth
Ranch Employee
Other
If from online ad or employee please list the name of the site or the employee's name.
I attest that the information listed above is true and correct to the best of my knowledge. I understand that a secondary step in the application process is the satisfactory outcome of the mandatory criminal background check required by the State Department of Human Resources.
Do you agree with the terms and conditions?
*
Yes, I agree.
Initial
*
Date
*
MM
/
DD
/
YYYY
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