Employment Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 4Personal Information Position Applying For *Location *HoldregeLexingtonGothenburgDate *Date Availble *Name *FirstLastEmail *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome Phone *Cell PhoneWork PhoneAre you 16 years of age or older? *YesNoIf hired, can you provide verification of your legal right to work in the United States? *YesNoCan you perform the essential functions of the job for which you are applying, with or without reasonable accommodation *YesNoHave you ever been convicted of a crime, pled no contest, or had adjudication withheld? *YesNoIf 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 when 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. NextEmployment Information List available days/hours Sunday *Monday *Tuesday *Wednesday *Thursday *Friday *Saturday *Preferred Job Status *Full-timePart-timeSeasonalAs NeededHave you previously been employed by this YMCA or any other YMCA? *YesNoIf yes, when? At which locations? *Have you previously volunteered at this YMCA or any other YMCA? *YesNoIf yes, when? At which locations? *Do you have any relatives or household members currently working for this YMCA? *YesNoIf yes, name(s) and relationship *How did you hear about this opening?YMCA staff referralSchoolWalk-inYMCA websiteYMCA memberAdvertisementOtherName of referral source *Education & Training Educational Background High School or GED *High SchoolGEDName of School *City, State *Diploma Awarded *YesNoIn ProgressCollege DegreeName of CollegeMajorCity, StateDiploma AwardedYesNoIn ProgressGraduate School DegreeName of Graduate SchoolMajorCity, StateDiploma AwardedYesNoIn ProgressVocational / Other DegreeName of School - Vocational/OtherMajorCity, StateDiploma AwardedYesNoIn ProgressDescribe any non-employment experience such as school or volunteer activities that might strengthen your application *Safety & Job Specific Certifications; Lifeguard CertificationType (CPR, First Aid, CDA, etc.)ProviderLevelExpirationType (CPR, First Aid, CDA, etc.)ProviderLevelExpirationType (CPR, First Aid, CDA, etc.)ProviderLevelExpirationPreviousNextEmployment History List all previous employment during the past seven years starting with the most recent. Employer Name *Telephone *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob Title *Immediate Supervisor and Title *Reason for Leaving *Employed From *Starting Hourly Rate/Salary *To *Ending Hourly Rate/Salary *Summarize the nature of the work performed and job responsibilities *May we contact this employer? *YesNoEmployment #2EmployerTelephoneAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob TitleImmediate Supervisor and TitleReason for LeavingEmployed FromStarting Hourly Rate/SalaryToEnding Hourly Rate/Salary Summarize the nature of the work performed and job responsibilitiesMay we contact this employer?YesNoEmployment #3EmployerTelephoneAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob TitleImmediate Supervisor and TitleReason for LeavingEmployed FromStarting Hourly Rate/SalaryToEnding Hourly Rate/SalarySummarize the nature of the work performed and job responsibilitiesMay we contact this employer?YesNoEmployment #4EmployerTelephoneAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob TitleImmediate Supervisor and TitleReason for LeavingEmployed FromStarting Hourly Rate/SalaryToEnding Hourly Rate/SalarySummarize the nature of the work performed and job responsibilitiesMay we contact this employer?YesNoAdditional InformationPlease 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?PreviousNextReferences Please include one relative. Name *FirstLastRelationshipPhone *Alternate #Reference #2Name *FirstLastPosition *Phone *Years Known *Alternate #Reference #3NameFirstLastPositionPhoneYears KnownAlternate # Reference #4NameFirstLastPositionPhoneYears KnownAlternate # 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, other than the CEO of the YMCA, no manager, supervisor or representative of the YMCA has authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. Only the CEO of the YMCA has the authority to make any agreement contrary to the foregoing and then only in writing. 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. Applicant Signature * Clear Signature Date of Application *Apply
