Employment Application

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Position Information

Position Applying for:

Y Kids Club

Part-Time Member Services Staff

Referees

Janitorial Attendant

Date Available:

Personal Information

Full Name

Include Last name, First name, MI

Phone

Address

Address 2

City

State

ZIP Code

Email Address

Confirm email

Work Status

Are you 18 years of age or older? (If not, you may be required to provide work authorization.)

Yes

If hired, can you provide verification of your legal right to work in the United States?

Yes

Can you perform the essential functions of the job for which you are applying, with or without reasonable accommodation?

Yes

Have you ever been convicted of a crime, per no contest, or had adjudication withheld?

Yes

If yes, please provide a date, location, charges and a complete explanation of all offenses. (A conviction will not necessarily bar employment. The YMCA may consider the nature, date and circumstances of the offenses.)

Notice to all applicants: The YMCA enforces its policies and practices to prevent child abuse.

Allegations or suspicions of child abuse are taken very seriously at the YMCA and will be reported to the proper authorities for investigation. We have abuse reporting procedures, there are unscheduled visits from supervisors, we have an open door for parents, and we have a code of conduct for staff. We minimize opportunities for abuse to occur and we talk with children about personal safety and touching limits. We also screen carefully to prevent abusers from being hired.

What is your desired wages/salary range?

How did you hear about this opening?

YMCA Staff referral

School

Walk-In

YMCA website

YMCA Member

Other…

Name of referral source:

Education & Training

Educational Background

Name of School	City, State	Diploma Awarded	Year Completed	Degree/Major
High School or GED	City and State	Diploma Awarded	Year Completed	Degree/Major
College	City and State	Diploma Awarded	Year Completed	Degree/Major
Graduate School	City and State	Diploma Awarded	Year Completed	Degree/Major
Vocational / Other	City and State	Diploma Awarded	Year Completed	Degree/Major

Describe any non-employment experience such as school or volunteer activities that might strengthen your application:

Safety & Job Specific Certifications

Type (CPR, First Aid, CDA, etc.)	Provider	Level	Expiration
Type (CPR, First Aid, CDA, etc.)	Provider	Level	Expiration
	Provider	Level	Expiration

Additional Information:

Please list any specialized training, apprenticeships, skills, or experiences that may be beneficial in working at the YMCA.

Employment History

List all previous employment during the past seven years. Starting with the most recent. Use additional sheets if needed.

Employer

Address

Telephone

Date Employed:

Provide start and end date.

Hour Rate / Salary

Provide Starting and Final

Supervisor

Job Title

Reason for leaving:

Work Performed:

Employer

Address

Telephone

Date Employed:

Provide start and end date.

Hour Rate / Salary

Provide Starting and Final

Supervisor

Job Title

Reason for leaving:

Work Performed:

Employer

Address

Telephone

Date Employed:

Provide start and end date.

Hour Rate / Salary

Provide Starting and Final

Supervisor

Job Title

Reason for leaving:

Work Performed:

Employer

Address

Telephone

Date Employed:

Provide start and end date.

Hour Rate / Salary

Provide Starting and Final

Supervisor

Job Title

Reason for leaving:

Work Performed:

Comments: Include explanation of any gaps in employment:

Personal References

Please only list one relative.

Name:

Occupation:

Year s Known:

Address:

City, State, Zip:

Email:

Phone:

Alternate #:

Name:

Occupation:

Year s Known:

Address:

City, State, Zip:

Email:

Phone:

Alternate #:

Name:

Occupation:

Year s Known:

Address:

City, State, Zip:

Email:

Phone:

Alternate #:

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Upload your Resume

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200 MB limit.
Allowed types: jpg, jpeg, png, gif, pdf, doc, docx, xls, xlsx.

Application Acknowledgement and Authorization

Please read all statements and sign below.

I authorize both the YMCA and persons listed (references, schools, current (unless noted) and former employers and any others with whom you desire to check) to communicate with regard to any relevant information that may be required to reach an employment decision. I agree to hold such persons harmless with respect to any information they may supply. I understand and agree that any offer of employment is contingent upon successful completion of all background check processes, including a criminal history background check.

I certify that all information provided by me in this application is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation, or omission of any facts in this application or any other document submitted in connection with YMCA employment will result in denial of employment or termination of employment regardless of the timing or circumstances of discovery. If I am employed by the YMCA I understand my employment can be terminated, with or without cause and with or without notice, at any time at the option of the YMCA or myself.

I understand that all offers of employment are conditional upon my ability to provide appropriate documents regarding my identity and legal right to work in the United States. I understand that this application is only valid for the position applied for at present and that the YMCA is not obligated to retain or consider this application for future openings. If hired, I agree to abide by YMCA policies and rules at all times. I acknowledge that I have read the above statements and understand them. I understand that the YMCA is an equal opportunity employer and does not discriminate in the recruitment, hiring or other terms or conditions of employment on the basis of race, color, religion, national origin, sex, disability, age or any other status protected by
law.

Signature:

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Today Date: