Employment Application Employment Application If you are human, leave this field blank. Position Applying For: Fitness Instructor Wellness Center Welcome Desk Sports Officials/Referees Sports Scorekeepers Name Email Address Address City State Zip 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 further expressly agree that, with respect to the at-will employment relationship, this constitutes the full, complete and final expression of the parties’ intent concerning the nature of any employment relationship between myself and the YMCA. 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. Home Phone Business Phone Mobile Phone Are you 18 years of age or older? (if not, you may be required to provide work authorization.) Yes No If hired, can you provide verification of your legal right to work in the United States? Yes No Can you perform the essentioal functions of hte job for which you are applying, with or without reasonable accomodation? Yes No 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 and we provide child abuse prevention training to staff. Employment Information LIst available hours/days: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Preferred Job Status: Full-Time Part-Time Seasonal As Needed Have you previously been employed by this YMCA or any other YMCA? Yes No If yes, when? At which locations? Have you previously volunteered at this YMCA or any other YMCA? Yes No If yes, when? At which locations? Do you have any relatives or household members currently working for this YMCA? Yes No If yes, name(s) and relationship: How did you hear about this opening? YMCA staff referral School Walk-in YMCA website YMCA member Advertisement Other Please describe how you heard about this opening. Education & Training High School/GED Name of School City, State Diploma Awarded Yes No In Progress Degree Major College Name of School City, State Diploma Awarded Yes No In Progress Degree Major Graduate School Name of School City, State Diploma Awarded Yes No In Progress Degree Major Vocational/Other Name of School City, State Diploma Awarded Yes No In Progress Degree Major Describe any non-employment experience such as school or volunteer activities that might strengthen your application: Type (CPR, First Aid, CDA, etc.) Provider Level Expiration Type (CPR, First Aid, CDA, etc.) Provider Level Expiration Type (CPR, First Aid, CDA, etc.) Provider Level Expiration Employment History Employer Phone Number Address Job Title Immediate Supervisor and Title Reason for Leaving May we contact this employer? Yes No Dates Employed Date From Date to Starting Hourly Rate/Salary Summarize the nature of the work performed and job responsibilities. Employer Phone Number Address Job Title Immediate Supervisor and Title Reason for Leaving May we contact this employer? Yes No Dates Employed Date From Date to Starting Hourly Rate/Salary Summarize the nature of the work performed and job responsibilities. Employer Phone Number Address Job Title Immediate Supervisor and Title Reason for Leaving May we contact this employer? Yes No Dates Employed Date From Date to Starting Hourly Rate/Salary Summarize the nature of the work performed and job responsibilities. Employer Phone Number Address Job Title Immediate Supervisor and Title Reason for Leaving May we contact this employer? Yes No Dates Employed Date From Date to Starting Hourly Rate/Salary Summarize the nature of the work performed and job responsibilities. Please explain any gaps in your employment history. What other business experience, personal experience or training have you had that may have prepared you for this position? Personal References Do not list relatives or past employers. Name Occupation Years Known Address City State Zip Email Address Phone Number Alternate Phone Personal References Do not list relatives or past employers. Name Occupation Years Known Address City State Zip Email Address Phone Number Alternate Phone Personal References Do not list relatives or past employers. Name Occupation Years Known Address City State Zip Email Address Phone Number Alternate Phone Application Acknowledgement and Authorization Thank you for your interest in the YMCA! The YMCA is an equal opportunity employer and does not discriminate in 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. If you would like to apply to join the YMCA staff team, please complete the application below. •Be sure to write legibly •The application must be completed in full. •Do not leave any spaces blank or write “see resume” in response to any question. •Read and sign the last page of the application. Signature Clear Date reCAPTCHA
