Northern Lights YMCA
Employment Application
General Information
Name
*
First Name
Last Name
Application Date
*
-
Month
-
Day
Year
Date
For which location are you applying?
*
Delta County
Dickinson County
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
*
Please enter a valid phone number.
Secondary Phone Number (optional)
Please enter a valid phone number.
Email
*
example@example.com
Are you at least 18 years old?
*
Yes
No
If no, please provide your date of birth
-
Month
-
Day
Year
Date
Have you ever been convicted of a crime (felony or misdemeanor)?
*
Yes
No
If yes, explain 1) nature of the crime, 2) The date of the conviction, and 3) The state in which convicted.
*Please note that convictions are not an automatic bar to employment. However, failure to provide complete and accurate information related to the criminal convictions is cause for immediate termination. Employment is contingent upon the results of a criminal record check.
Area of Employment Desired
Area of Employment Desired
*
Health and Fitness
Youth Sports
Aquatics
Finance/Accounting
Customer Service
Facility Services
Youth/Teen Recreation
Child Care
Camp
Specific Position(s) applying for:
*
Have you applied here before? If yes, when?
*
Have you ever been an employee or volunteer? If yes, when?
*
Availability
Please check all that apply:
*
Part-time
Full-time
Year-round
Summer
School year
Show all availability in the table below:
*
Times Available
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Date you can begin
*
-
Month
-
Day
Year
Date
Education and Certifications
Education
*
Type of School
Name, City, and State
Years Completed
Graduation Year
Major Course of Study
1.
2.
3.
4.
List any current certifications below. Include the certifying agency (ex. American Red Cross) and the expiration date.
Interests and Qualifications
Please explain why you want to work for the Northern Lights YMCA.
*
Please explain why you are interested in the specific position(s) you are applying for.
*
Please explain what makes you feel you are qualified for the specific position(s) you are applying for.
*
Employment Experience
Please list employers in chronological order with most recent first, and include military service assignments and volunteer activities.
Employer One
Information
Employer
Employer Phone Number
Dates Employed
Address
Your Job Title
Starting Wage
Ending Wage
Work Performed
Supervisor
Reason for Leaving
May we contact?
Employer Two
Information
Employer
Employer Phone Number
Dates Employed
Address
Your Job Title
Starting Wage
Ending Wage
Work Performed
Supervisor
Reason for Leaving
May we contact?
Employer Three
Information
Employer
Employer Phone Number
Dates Employed
Address
Your Job Title
Starting Wage
Ending Wage
Work Performed
Supervisor
Reason for Leaving
May we contact?
References
Please list three persons, whom you have known for at least one year.
Reference One
Information
Reference Name
Day Phone Number
Evening Phone Number
Address
Email Address
Occupation/Relationship
Years Known
Reference Two
Information
Reference Name
Day Phone Number
Evening Phone Number
Address
Email Address
Occupation/Relationship
Years Known
Reference Three
Information
Reference Name
Day Phone Number
Evening Phone Number
Address
Email Address
Occupation/Relationship
Years Known
How did you learn about the position(s) that you are applying for? Please check all that apply.
NLYMCA Website
National YMCA Vacancy List
Michigan Works
Newspaper
Job Fair
Inquiry to the YMCA
YMCA Employee
Word of Mouth
Indeed
Other
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Application Process Policy
In accordance with our policy to recruit and hire on an equal opportunity basis without regard to race, creed, color, religion, sex, age, national origin, sexual preference, disability, veteran status, or any other characteristic protected by law, the Northern Lights YMCA adheres to the following job applicant policies and procedures: 1. Applications may be submitted in person, mailed, faxed, or electronically mailed. 2. Resumes must be accompanied by this completed employment application if applicable. 3. Incomplete applications may not be accepted. 4. At time we may limit the number of accepted applications for highly solicited positions on a first-come, first-served basis. The number of applications accepted will be determined by the position. 5. Applications will be considered as active for four calendar months following the original application date. 6. Only accepted applications that are considered active will be forwarded to the hiring director(s). Accepted, active applications for open positions will be forwarded to the hiring director(s) for consideration and interview scheduling.
Statement of Application
Please read this carefully before signing this form. 1. All information contained in this application is true and correct to the best of my knowledge. I understand that misrepresentation of omission of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired. 2. I authorize the Northern Lights YMCA to investigate my background and responses on this application and to contact present and former employers (except as indicated) or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly full release and hold harmless the person or organization that provides information pertaining to me, or my employment. 3. Regardless of whether or not I become employed at the Northern Lights YMCA, I recognize that this application is not to be considered a contract for employment. I understand that employment at the Northern Lights YMCA is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or at the option of the Northern Lights YMCA.
Signature
Date
-
Month
-
Day
Year
Date
Submit
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