Monroe County YMCA EMPLOYMENT APPLICATION

Monroe County YMCA EMPLOYMENT APPLICATION
First and Last Name*
Phone*
Format: (000) 000-0000.
Email*
Position Applying For*
Available Start Date*

MonthDayYear
Date
Please attach a resume & cover letter*

Cancelof
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you under the age of 18?*

YesNo
Please provide your birthdate:

MonthDayYear
Date
Which Y branch are you applying for:*

Southeast BranchNorthwest BranchBoth

Please indicate the hours you are available to work. The YMCA operates seven days a week with hours of operation changing per season and facility. Please check the website for branch hours.

Rows	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday

List current certifications*

Education*

Rows	Name & Location of School	Years Attended	Diploma or Degree received	Degree/Major
High School
College
Graduate
Vocational or Trade School

Attach any other documentation:

Cancelof

Employment*

Rows	Date of Employment	Name/Address/Phone of Employer	Position	Reason for Leaving

May we contact the employers listed above?*

YesNo
Have you ever been employed at this YMCA?*

YesNo
Please share the circumstances behind your departure.

References*

Rows	Name	Email	Phone	Occupation	Years Known
Ref # 1
Ref # 2
Ref # 3

Are you eligible to work in the U.S. ?*

YesNo
Have you ever been convicted of a crime?*

YesNo
If yes, please explain circumstances:
Date of conviction:
Name & location of court:
Offense:
Sentence & fine imposed:
What do you see as the mission of the Monroe County YMCA?*
I understand and agree that:

1. If I am offered and accept employment with the company, my employment is considered at-will, is for no definite period of time, and may be terminated with or without cause. I further understand that this application for employment is not a contract of employment.

2. Any misrepresentation or deliberate omission on this application may be justification for refusal of or termination of employment. The YMCA does a criminal history check on any applicant or employee over age 18.

3. The YMCA will check references and verify information given. I authorize this investigation and I release any persons, corporations or other institutions for giving or receiving additional information.

4. I have read and understand the above.
Signature*
Date*

MonthDayYear
Date
The Monroe County YMCA is an equal opportunity employer. The YMCA does not discriminate in employment. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, disability status, protected veteran status, or any other characteristic protected by law.
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