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