YMCA JOB APPLICATION HELEN G. NASSIF YMCA MARION YMCA PRAIRIE SUMMIT YMCA A complete list of job openings can be found on our CAREERS page. YMCA JOB APPLICATION DATE Name STREET ADDRESS ADDRESS LINE 2 (if needed) CITY STATE ZIP Email PHONE WHAT POSITION ARE YOU APPLYING (CAMP WAPSIE USE THE WAPSIE APPLICATION ABOVE) Aquatics Director- Prairie Summit YMCA Helen G. Nassif YMCA Preschool Teacher's Assistant Summer Day Camp Counselor - Helen G. Nassif YMCA and Marion YMCA (seasonal) Lifeguard Youth Sports Official Swim Team Lane Coach - Helen G. Nassif YMCA Swim Lesson Instructor OTHER IF YOU SELECTED "OTHER" PLEASE NOTE DETAILS HERE PREFERRED LOCATION Helen G. Nassif YMCA Marion YMCA Metro No preference For Camp Wapsie please use the Camp Wapsie application link above AVAILABILITY Full-Time Part Time Seasonal PREFERRED SHIFT Morning Afternoon Evening Weekend HAVE YOU EVER WORKED FOR A YMCA? Yes No IF SO WHICH YMCA? WAGE DESIRED Relevant Skills, Training and/or Certifications CHECK ALL THAT APPLY I am under the age of 16 I am over the age of 16 I am over the age of 18 IF HIRED ARE YOU `ABLE TO PROVIDE LEGAL VERIFICATION OF YOUR RIGHT TO WORK? Yes No PLEASE LIST ANY FAMILY MEMBERS OR FRIENDS WHO WORK FOR THE YMCA AND THEIR RELATIONSHIP TO YOU. HOW DID YOU HEAR ABOUT THIS POSITION? Family Friend Social Media YMCA Employee Newspaper Job Site Listing Other 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 HIGH SCHOOL YEAR COMPLETED 9 10 11 12 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? No Yes 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
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