Sample Employment Application Form - Gateway Region YMCA

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Home Phone. Cell Phone. Employment ... I certify that facts set forth in this application for employment are true and co
GATEWAY REGION YMCA APPLICATION FOR EMPLOYMENT Date

PERSONAL INFORMATION Name Last

First

Middle

Address Number/Street

City

Email

Employment desired

State

Home Phone

FULL-TIME ONLY

Are you 18 years of age or older?

No

Cell Phone

PART-TIME ONLY

Yes

FULL- OR PART-TIME

TEMPORARY

When are you available for work?

If under 18 years of age, date of birth:

No Preference

Thursday

Monday

Friday

Tuesday

Saturday

Wednesday

Sunday

Position applied for: Salary desired:

How many hours can you work weekly?

Can you work nights?

Have you ever been employed by this organization?

Zip

No

No

Yes

Yes

If so, what department were you employed in? Date last employed:

Reason for leaving:

Do you have relatives currently employed by the YMCA?

No

Yes

Do you have any physical or medical condition which would limit your capacity for the job applied?

If yes, please describe the condition and explain your work limitations.

No

Yes

WORK EXPERIENCE Employer Address Name of last Supervisor Dates of Employment

Phone Number

Last Job Title to

Last Salary

Reason for leaving (be specific) Employer Address Name of last Supervisor Dates of Employment

Phone Number

Last Job Title to

Last Salary

Reason for leaving (be specific) Employer Address Name of last Supervisor Dates of Employment

Phone Number

Last Job Title to

Last Salary

Reason for leaving (be specific)

EDUCATION School/University

Location

Major

Date Graduated

Phone Number

Years Acquainted

REFERENCES Name

Email Address

APPLICANT’S RELEASE, CERTIFICATION, AND AGREEMENT I certify that facts set forth in this application for employment are true and complete to the best of my knowledge. I understand if employed, false statements on this application shall be considered sufficient cause for dismissal. It is understood employment with the YMCA of the Gateway Region YMCA is subject to passing a criminal record check. The organization is hereby authorized to conduct a police record check and make any investigation of my prior education and work history. I understand if I am hired, the length of my employment is not guaranteed, recognizing I will be free to voluntarily terminate my employment at any time, with our without cause, I acknowledge the organization will be free to voluntarily terminate my employment at any time, with or without case. Signature of Applicant

Date