LEARN, LEAD AND SERVE!

Transcription

1 LEARN, LEAD AND SERVE! Greater Naples YMCA Employment Application YMCA ROAD NAPLES, FL

2 Greater Naples YMCA EMPLOYMENT APPLICATION The Greater Naples YMCA is an Equal Opportunity Employer. Applicants will be considered without regard to race, color, religion, national origin, sex, age, sexual orientation, disabilities, or any other basis protected by state, federal or local law. It is the intent of the YMCA to comply with all applicable federal, state, and local legislation concerning equal opportunity in employment. PERSONAL INFORMATION Last Name First Name MI Date of Application Social Security # Phone # Home or Cell (Circle 1) Are you under 18? Desired department and/or position? No If under age 18, please enter birth date: Status desired? Full Time Part Time / / Date available for work? / / Have you ever worked for a YMCA? No Shift availability restrictions? Current street address City State Zip Code None address What interests you about the Greater Naples YMCA? PREVIOUS EMPLOYMENT

3 EDUCATION TYPE NAME AND LOCATION DEGREE/MAJOR G.P.A. GRADUATE SCHOOL NO. OF YEARS ATTENDED? GRADUATED? (CHECK ONE) NO COLLEGE NO HIGH SCHOOL NO OTHER NO SPECIALIZED SKILLS, TRAININGS & CERTIFICATIONS Please check if you have any training or experience in the following areas: CPR Lifeguard First Aid Tennis Customer Service Child Care 40 hours training Housekeeping PC/MAC Spreadsheets/Accounting Maintenance Other (please list below) State any additional information you feel may be helpful to us in considering your application: REFERENCES (Professional and/or work references for contact) 1 : 2 : 3 : CRIMINAL AND OTHER OFFENSES Have you ever been convicted of or plead guilty or nolo contender (no contest) to a crime? (Information pertaining to sealed or expunged conviction records need not be disclosed.) NO If yes, please explain: Have you ever been a defendant in a civil action for an intentional tort? NO If yes, provide details, including the nature of the tort and the disposition. Have you ever been convicted of a felony or for child abuse or sex-related crimes? NO If yes, please explain.

4 PRE-EMPLOYMENT CERTIFICATION READ, UNDERSTAND, SIGN AND DATE IF YOU AGREE My signature below certifies that I have read and understand the foregoing, and to the best of my knowledge and belief, the information on this application is true, correct and complete without misrepresentations or omissions of any kind whatsoever. I authorize investigation of the statements I have made herein. I hereby release from any and all liability all representatives of the Greater Naples YMCA for their acts performed in connection with evaluating my application, background, credentials and qualifications. I hereby further authorize any party (including the companies, schools, and organizations listed in this application form) to release any information they may have about me to the Greater Naples YMCA, including all of my personnel records with prior employers. I also release all persons, companies, schools and organizations (and all persons connected with them) who provide such information to the Greater Naples YMCA of any and all liability for any damage for giving this information. I understand that if any of the information on this application form is discovered to be incorrect, false or misleading or if there are any misrepresentations or omissions of any kind whatsoever, then the Greater Naples YMCA may deny me employment or terminate my employment, and I agree that the Greater Naples YMCA shall not be liable in any respect if it does so. I also understand that if I am employed by the Greater Naples YMCA, any such employment is not binding on either party for any specific period of time. I further understand that no representative of the Greater Naples YMCA, other than the President / CEO, has any authority to enter into any agreement for employment for any specified period of time. Any such agreement must be in writing and signed by the President / CEO. I understand that any other written or oral statement to the contrary, even if made by a supervisor, manager or other officer of the Greater Naples YMCA, is invalid and should not be relied upon by me. I understand that if employed, I will be an employee-at-will and that either the Greater Naples YMCA or I may terminate the employment relationship at any time for any reason, with or without notice. Signature of applicant Date Please submit your completed application to the Member Services Desk at the Greater Naples YMCA.

5 NOTICE AND ACKNOWLEDGMENT [IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGMENT] NOTICE REGARDING BACKGROUND INVESTIGATION Employer ( the Company ) may obtain information about you from a consumer reporting agency for employment purposes. Thus, you may be the subject of a consumer report and/or an investigative consumer report which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may be obtained at any time after receipt of your authorization and, if you are hired, throughout your employment. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by Global HR Research, 9530 Marketplace Road, Suite 301, Fort Myers, FL 33912, Office: (239) , Toll Free: , website: or another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing Employer to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and, if you are hired, throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report. New York and Maine applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting the consumer reporting agency identified above directly. You may also contact the Company to request the name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries, which the Company shall provide within 5 days. New York applicants or employees only: Upon request, you will be informed whether or not a consumer report was requested by the Company, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. Oregon applicants or employees only: Information describing your rights under federal and Oregon law regarding consumer identity theft protection, the storage and disposal of your credit information, and remedies available should you suspect or find that the Company has not maintained secured records is available to you upon request. Washington State applicants or employees only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. ACKNOWLEDGMENT AND AUTHORIZATION I acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of consumer reports and/or investigative consumer reports at any time after receipt of this authorization and, if I am hired, throughout my employment. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Global HR Research, another outside organization acting on behalf of Employer, and/or Employer itself. I agree that a facsimile ( fax ), electronic or photographic copy of this Authorization shall be as valid as the original. Minnesota and Oklahoma applicants or employees only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by the Company. California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report if one is obtained by the Company at no charge whenever you have a right to receive such a copy under California law. DATE Current PRINT NAME (First, Middle, Last) SIGNATURE OF EMPLOYEE OR PROSPECTIVE EMPLOYEE SOCIAL SECURITY NUMBER Date of Birth (For Background Purposes Only) Drivers License Number State Previous Addresses (Last 7 years): Any other names I have been known by (including maiden name):