DUNELAND FAMILY YMCA JOB APPLICATION
Position Applying for:
Today's Date
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Month
-
Day
Year
Date
Date Available to Begin Work
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Month
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Day
Year
Date
Name
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First Name
Last Name
Phone
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Email
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example@example.com
Address
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City
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State
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Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
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Are you 18 years of age or older? (If not, you may be required to provide work authorization.)
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Yes
No
If hired, can you provide verification of your legal right to work in the United States?
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Yes
No
Can you perform the essential functions of the job for which you are applying, with or without reasonable accommodation?
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Yes
No
Have you ever been convicted of a crime, pled no contest, or had adjudication withheld?
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Yes
No
If yes to the previous question, 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.) If no, please type N/A.
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EMPLOYMENT INFORMATION
Please Provide Your Availability
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Preferred Job Type
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Full-time
Part-time
Seasonal
As needed
Have you previously been employed by this YMCA or any other YMCA?
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Yes
No
If yes to the previous question, when and which location?
Do you have any relatives or household members currently working for this YMCA?
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Yes
No
If yes to the previous question, please list name(s) and relationship.
How did you hear about this opening?
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Please Select
YMCA Staff Referral
School
YMCA Website
YMCA Member
Advertisement
Other
If YMCA staff referral or other, please explain.
EDUCATION AND TRAINING
Please Describe Your Educational Background
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Describe any non-employment experience such as school or volunteer activities that might strengthen your application. If none, type N/A.
Please list any safety and/or job specific certifications: EX: (CPR, First Aid, CDA, etc.) Please list the provider, level and expiration of certifications.
EMPLOYMENT HISTORY
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Please List 3 Personal References
DO NOT LIST RELATIVES OR PAST EMPLOYERS.
Reference 1
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Reference 2
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Reference 3
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Application Acknowledgement & Authorization
Please read all statements and sign below.
Signature
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