DATE
Name
STREET ADDRESS
ADDRESS LINE 2 (if needed)
CITY
STATE
ZIP
Email
PHONE
WHAT POSITION ARE YOU APPLYING FOR?
IF SO WHICH YMCA?
WAGE DESIRED
Relevant Skills, Training and/or Certifications
IF HIRED ARE YOU `ABLE TO PROVIDE LEGAL VERIFICATION OF YOUR RIGHT TO WORK?
Yes
No
Message
PLEASE LIST ANY FAMILY MEMBERS OR FRIENDS WHO WORK FOR THE YMCA AND THEIR RELATIONSHIP TO YOU.
REFERENCE #1 NON FAMIILY MEMBER NAME
REFERENCE #1 PHONE
REFERENCE #1 EMAIL
REFERENCE #1 CITY, STATE
REFERENCE #1 RELATIONSHIP TO YOU AND OCCUPATION
REFERENCE #2 NON FAMIILY MEMBER NAME
REFERENCE #2 PHONE
REFERENCE #2 EMAIL
REFERENCE #2 CITY, STATE
REFERENCE #2 RELATIONSHIP TO YOU AND OCCUPATION
HIGH SCHOOL NAME/CITY/STATE
COLLEGE ATTENDED
COLLEGE ADDRESS CITY/STATE
COLLEGE DEGREE (if applicable)
OTHER CERTIFICATIONS OR DEGREE (Trades, License, Certification)
NOTES AND INFORMATION
GRADUATE DEGREES RECEIVED
GRADUATE COLLEGE NAME
GRADUATE COLLEGE CITY/STATE
ARE YOU CURRENTLY EMPLOYED
Yes
No
EMPLOYER NAME
EMPLOYER CITY/STATE
CURRENT JOB TITLE
DUTIES
START DATE
END DATE
WAGE (NOTE YEARLY OR HOURLY)
SUPERVISOR NAME
SUPERVISOR PHONE
SUPERVISOR EMAIL
PHONE
WHY DID YOU LEAVE? If currently employed note "employed" in this field
MAY WE CONTACT THIS EMPLOYER?
Yes
No
EMPLOYER#2 NAME
EMPLOYER #2 CITY/STATE
JOB #2 TITLE
PHONE
DUTIES
START DATE
END DATE
WAGE (NOTE YEARLY OR HOURLY)
SUPERVISOR PHONE
SUPERVISOR EMAIL
UPLOAD RESUME IF AVAILABLE
In the past 10 years, have you ever been discharge or suspended form employment for disciplinary reason or have you been asked to resign?
Yes
No
If YES please explain.
Have you ever been convicted of a crime, had adjudication withheld, or pled no contest to a crime?
Yes
No
If yes, please state the type of crime and the circumstances with regard to each including date of conviction, or plea and the penalty, if any imposed by the court.
Have you ever been convicted or had any administrative finding of violating any law involving child abuse, sexual abuse, physical abuse, child endangerment, sexual harassment or exploitation or crime related to children?
Yes
No
If yes, please state the type of crime and the circumstances with regard to each including date of conviction, or plea and the penalty, if any imposed by the court.
Do you currently have any charges pending relating to any of the aforementioned?
Yes
No
If yes, please explain.
If the position for which you are applying requires a valid driver's license, do you have one?
Yes
No
Have your driving privileges been suspended or revoked in the past 3 years?
Yes
No
If yes please explain
Why do you wish to work for the Cedar Rapids Metropolitan YMCA?:
Please describe your involvement within the community, volunteer groups and other organizations:
If you feel there is additional information about yourself regarding your skills, experience, accomplishments, etc., that would assist us in evaluating your application, please share the details.
I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand and agree that any misrepresentation or omission of facts would exclude my being considered for employment, or, after employment, would be cause for termination of employment with the YMCA of the Cedar Rapids Metropolitan Area (YMCA). I understand and agree that if I am employed, there is no contract period for employment, and my employment would be solely “employment at will”, giving either me or the YMCA the right to terminate my employment at any time without liability or obligation, except for my regular pay through date of termination. I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE ABOVE STATEMENTS AND THAT I VOLUNTARILY SIGN THIS EMPLOYMENT APPLICATION. I understand and acknowledge the above:
SUBMIT