MONTGOMERY YMCA APPLICATION FOR EMPLOYMENT

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1 RETURN TO BRANCH: MONTGOMERY YMCA APPLICATION FOR EMPLOYMENT YMCA Mission To put Christian principles into practice through programs that build a healthy body, mind and spirit for all. Equal Opportunity Employer The YMCA offers equal employment opportunities to all persons without regard to race, color, religion, creed, age, marital or veterans status, gender, national origin, disability or any other legally protected status. PERSONAL INFORMATION Last Name First Name Middle Initial Date of Application Current Address City State Zip Code Permanent Address City State Zip Code Home Phone Business Phone Cell Phone Pager Address Are you under 18 years of age? Yes No If you are under the age of 16, you will be required to furnish a certificate of eligibility to work. Do you have a valid driver s license? Yes No Do you have automobile insurance? Yes No EMPLOYMENT INTEREST Position Desired Branch Salary/Wages Desired Date Available to Start Work Hours and Days Available Time Period Available (e.g. summer) Have you previously been employed by the YMCA? Yes No If yes, where and when: How did you learn of this opportunity? 1

2 Why do you want to work at the YMCA? EDUCATION AND TRAINING School Attended City, State Major Year Graduated Degree Received EMPLOYMENT HISTORY (please list most recent employer first) 2

3 CERTIFICATIONS AND RELATED WORK EXPERIENCE Certificate Expiration Date Certifying Agency You may be requested by the YMCA to provide proof of your certifications. Please list any other work experience that you have gained which you consider relevant to this application. EXTRA-CURRICULAR ACTIVITIES, HONORS AND ACHIEVEMENTS Please list any extra-curricular activities in which you participate that you consider relevant to this application. Please list any honors or achievements that you consider relevant to this application. REFERENCES (please list five references who have known you at least five years two may be relatives) Name Phone Number Relationship Years Known 3

4 OTHER INFORMATION Have you ever been convicted of a crime except a minor traffic violation? Yes No If yes, state the reason(s) and date(s): (Previous convictions do not necessarily disqualify an applicant from employment.) Have you ever been discharged or requested to resign from a position? Yes No If yes, state the circumstances: APPLICANT S AGREEMENT AND CERTIFICATION (please read carefully and sign) I certify that the information provided in this application for employment is true and complete in all respects, and I understand that any false or misleading information or omissions may disqualify me from further consideration for employment and may lead to my immediate discharge from employment if discovered at a later date. I understand that the YMCA may investigate my work and personal history and verify all information provided on this application, related papers and interviews. I authorize any person, school, current employer, past employer(s) and organizations named in this application to provide the YMCA with any information and opinion requested in connection with my application for employment, and I release all such persons from any liability or damages on account of having furnished such information or opinion. I understand that the YMCA reserves the right to conduct criminal history investigations to determine my qualifications for employment. I hereby authorize the YMCA to perform such investigations into my criminal history. I understand that the YMCA may require me to take a physical examination in order to determine if I am physically able to perform the physical requirements of the position for which I am applying. I also understand the YMCA may require me to take one or more drug tests as a prerequisite to employment or as a condition to continued employment. I hereby consent to such examinations and tests, and authorize the YMCA to conduct such examinations and tests, either prior to commencement of employment or after I have become employed, as the YMCA deems necessary. I understand that nothing contained in this application for employment creates an employment contract between the YMCA and me. No promises regarding employment have been made to me. I understand that, if hired, I am obliged to comply with any and all current and subsequently adopted YMCA policies and procedures. I also understand and agree that, if hired, either I or the YMCA may terminate my employment with or without cause and with or without prior notice, at any time for any reason. Applicant s Signature: Date: 4

5 RELEASE AUTHORIZATION In connection with my application for employment, I understand that an investigative consumer report may be requested that will include information as to my character, work habits, performance, and experience, along with reasons for termination of past employment. I understand that as directed by company policy and consistent with the job described, you may be requesting Last Name First Name Middle Initial information from public and private sources about my: driving record, criminal history, education, credentials, credit and references. According to the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained by my prospective employer from a consumer reporting agency. If so, I will be notified and provided with a copy of the report. I acknowledge that a fax or photographic copy shall be as valid as the original. Maiden Name/Other Names Used I hereby authorize, without reservation, any Law Enforcement Agency, Institution, Information Service Bureau, School, Employer, Reference or Insurance Company contacted by the Montgomery YMCA or its agent to furnish the information described in paragraph 1. The following must be filled out completely for your application to be considered. (Please print) Last Name First Name Middle Initial Maiden Name/Other Names Used Address Home Address City State Zip Code Date of Birth Social Security Number Driver s License Number State in which license was issued Signature Date YMCA of Montgomery Company Name Mona Martin Contact 880 South Lawrence Street Address Montgomery, AL City/State/Zip (334) (334) Phone Fax MVR (Driving Record) Criminal History SSN Link Sex Offender Registry

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