47 Foster Street, Marblehead, MA 01945
Phone: 781-631-1400      Fax: 781-631-1575
  • Application for Employment

    • Personal Information
      Experience

      Please list relevant experience even if it is not the most recent employment data. If currently employed, please list current employer even if experience is not relevant.

      Reference

      Please list three persons not related to you whom you have known at least one year.

      Please Read Before Signing

      We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age, sex, religion or national origin, ancestry or handicap of a qualified handicapped individual unless based upon a bona fide occupational qualification. In accordance with M.G.L. Chapter 249, Sec. 19B, Eastern Yacht Club does not administer or require a lie detector test as a condition of employment or continued employment.

      I hereby certify that all information provided on this application is true and correct. I understand that any falsification or omission is cause for dismissal or refusal of employment whenever discovered.

      I authorize investigation of all statements made in this application. I authorize disclosure of information about my past employment, volunteer work, experience and education. I release Eastern Yacht Club and its agents and employees from all liability in connection with any requests for information made by Eastern Yacht Club about me.

      I understand that if employed by the Eastern Yacht Club, I shall remain at all times an “at will” employee. I understand that nothing contained in the Eastern Yacht Club’s employment application, personnel policies or other written documents, nor any oral statements made to me by the Eastern Yacht Club representatives in connection with my application for employment or at any other time, shall constitute an actual or implied employment contract.

      NOTE: The Club reserves the right to check bags in the Clubhouse and on the Club premises

             
  • I-9 Form
  • Health History Form

    • Have you had any of the following:
      By initialing here I verify this information is correct.
             
  • CORI Form

    • REQUEST FOR PUBLICLY ACCESSIBLE MASSACHUSETTS CORI

       
      It is lawful to request this agency to provide a copy of another person’s publicly accessible adult conviction record. For the adult conviction record to be “publicly accessible” the person whose record is requested must have been convicted of a crime punishable by a sentence of five years or more, or has been convicted of any crime and sentenced to any term of imprisonment, and at the time of the request:

      1. is serving a sentence of probation or incarceration, or is under the custody of the parole board; or
      2. having been convicted of a misdemeanor, has been released from all custody or supervision not more than one year; or
      3. having been convicted felony, has been released from all custody or supervision for not more than two years; or
      4. having been sentenced to the custody of the department of correction, has finally been discharged therefrom, either having been denied release on parole or having been returned to penal custody for violating parole for not more than three years.

      Directions: Please fill this request form out as completely as possible. The more information you are able to provide, the more easily this agency will be able to process your request. A non-refundable processing fee of $30.00 is charged for each record requested and must be included with your request(s). There will be no exceptions made to this rule. Only checks or money orders made payable to the Commonwealth of Massachusetts will be accepted. A self-addressed, stamped envelope must also be enclosed with your request(s). Walk in requests or faxed requests will not be accepted. Requests will be processed in the order in which they are received. Mail all requests to: the Criminal History Systems Board, 200 Arlington Street, Suite 2200, Chelsea, MA 02150, ATTN: CORI Unit.

      All requests must be typed. Requests containing any illegible identifying information will be returned. If you are making more than one request, please copy this form and fill in the requested identifying information accordingly.

      1.

      2.

             
  • SORI Form

    • Commonwealth of Massachusetts
      Sex Offender Registry Board
      Request for Sex Offender Registry Information

      All requests for sex offender information must be made on this form and mailed to the Sex Offender Registry Board, Attn: SORI Coordinator, P.O. Box 4547, Salem, MA 01970, along with a self-addressed stamped envelope. The Board will provide a report that includes the following information: whether the person identified is a sex offender with an obligation to register, the offense(s) for which the offender was convicted or adjudicated, and the date(s) of the conviction(s) or adjudication(s). Please be advised that the law only permits the public to receive information on sex offenders required to register and finally classified by the Board as a level 2 (moderate risk) or level 3 (high risk) offender. Therefore, information is not available to the public if the identified individual is a level 1 (low risk) offender or if he/she has not yet been finally classified by the Board.

      All requests shall be recorded and kept confidential, except to assist or defend in a criminal prosecution.

      I swear under the pains and penalties of perjury that I am the above-named person, at least 18 years of age, and I am requesting information for my own protection, the protection of a child under 18 years of age, or for the protection of another person for whom I have responsibility, care or custody.

      I hereby request that the following information be used to determine whether the identified individual is a sex offender required to register in Massachusetts.

      Personal identifying characteristics:

      If additional information is needed, please contact the Requestor at the telephone number above.

      **********WARNING**********

      Sex Offender Registry Information shall not be used to commit a crime or to engage in illegal discrimination or harassment of an offender. Any person who uses information disclosed pursuant to M.G.L. C. 6, §§ 178C – 178P for such purposes shall be punished by not more than two and one half (2 ½) years in a house of correction or by a fine of not more than one thousand dollars ($1000.00) or both (M.G.L. C. 6, § 178N). In addition, any person who uses registry information to threaten to commit a crime may be punished by a fine of not more than one hundred dollars ($100.00) or by imprisonment for not more than six (6) months ( M.G.L. C. 275, § 4).

             
  • W-4 Tax Form
  • Authorization to Administer Medication to a Counselor

    • 105 CMR 430.160(A)
      Medication prescribed for campers shall be kept in original containers bearing the pharmacy label, which shows the date of filling, the pharmacy name and address, the filling pharmacist’s initials, the serial number of the prescription, the name of the patient, the name of the prescribing practitioner, the name of the prescribed medication, directions for use and cautionary statements, if any, contained in such prescription or required by law, and if tablets or capsules, the number in the container. All over the counter medications for campers shall be kept in the original containers containing the original label, which shall include the directions for use.

      105 CMR 430.160(C)
      Medication shall only be administered by the health supervisor* or by a licensed health care professional authorized to administer prescription medications. The health care consultant shall acknowledge in writing the list of medications administered at the camp. If the
      health supervisor is not a licensed health care professional authorized to administer prescription medications, the administration of medications shall be under the professional oversight of the health care consultant. Medication prescribed for campers brought from home shall only be administered if it is from the original container, and there is written permission from the parent/guardian.


      105 CMR 430.160(D)
      When no longer needed, medications shall be returned to a parent of guardian whenever possible. If the medication cannot be returned, it shall be destroyed.

      *Health Supervisor – A person who is at least 18 years of age, specially trained and certified in at least current American Red Cross First Aid (or its equivalent) and CPR, has been trained in the administration of medications and is under the professional oversight of a licensed health care professional authorized to administer prescription medications.