Uniontown YMCA Employment Application

Uniontown YMCA Employment Application

Complete this employment application using the extracted YMCA PDF fields. Match the existing YMCA form styling, logo, and color scheme.
Applicant Information
Position Applying For
Desired Salary
Application Date

MonthDayYear
Date
Preferred YMCA Location
Date Available

MonthDayYear
Date
Last Name
First Name
Middle Initial
Street Address
City
State
ZIP Code
Home Telephone
Please enter a valid phone number.Format: (000) 000-0000.
Business Telephone
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Telephone
Please enter a valid phone number.Format: (000) 000-0000.
Eligibility and Availability
Are you 18 years of age or older?
If hired, can you provide verification of your legal right to work in the United States?
Can you perform the essential functions of the job with or without reasonable accommodation?
Have you ever been convicted of a crime (other than a minor traffic offense)?
If yes, provide the date, location, charges, and explanation of all offenses
Availability - Monday
Availability - Tuesday
Availability - Wednesday
Availability - Thursday
Availability - Friday
Availability - Saturday
Availability - Sunday
Preferred Job Status
Have you ever been previously employed by the YMCA?
If yes, when and at which locations?
Have you ever been employed by a childcare center?
If yes, when and where?
Have you ever volunteered with the YMCA?
If yes, when and at which locations?
Do you have relatives or household members currently working for this YMCA?
If yes, provide names and relationship
How did you hear about this opening?
Name of referral source
Education and Background
High School/GED - Name of School
High School/GED - City/State
High School/GED - Diploma Awarded
High School/GED - Degree
High School/GED - Major
College - Name of School
College - City/State
College - Diploma Awarded
College - Degree
College - Major
Graduate School - Name of School
Graduate School - City/State
Graduate School - Diploma Awarded
Graduate School - Degree
Graduate School - Major
Vocational/Other - Name of School
Vocational/Other - City/State
Vocational/Other - Diploma Awarded
Vocational/Other - Degree
Vocational/Other - Major
Non-employment experience (school or volunteer) that might strengthen your application
Military Service - Branch
Military Service - Special training or skills
Safety & Job Specific Certifications
Employment History
Employer 1
Employer 1 Telephone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 1 Address
Employer 1 Dates Employed From

MonthDayYear
Date
Employer 1 Dates Employed To

MonthDayYear
Date
Employer 1 Job Title
Employer 1 Immediate Supervisor and Title
Employer 1 Starting Hourly Rate/Salary
Employer 1 Ending Hourly Rate/Salary
Employer 1 Reason for Leaving
Employer 1 May we contact this employer?
Employer 1 Summary of Work Performed and Job Responsibilities
Employer 2 Employer
Employer 2 Telephone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 2 Address
Employer 2 Dates Employed From

MonthDayYear
Date
Employer 2 Dates Employed To

MonthDayYear
Date
Employer 2 Job Title
Employer 2 Immediate Supervisor and Title
Employer 2 Starting Hourly Rate/Salary
Employer 2 Ending Hourly Rate/Salary
Employer 2 Reason for Leaving
Employer 2 May we contact this employer?
Employer 2 Summary of Work Performed and Job Responsibilities
Employer 3 Employer
Employer 3 Address
Employer 3 Dates Employed From

MonthDayYear
Date
Employer 3 Dates Employed To

MonthDayYear
Date
Employer 3 Summary of Work Performed and Job Responsibilities
Explain any gaps in your employment history
Other business, personal experience or training that may have prepared you for this position
References
Professional 1 - Name

First NameLast Name
Professional 1 - Position
Professional 1 - Years Known
Professional 1 - Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Professional 1 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Professional 1 - Email
example@example.com
Professional 1 - Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Professional 2 - Name

First NameLast Name
Professional 2 - Position
Professional 2 - Years Known
Professional 2 - Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Professional 2 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Professional 2 - Email
example@example.com
Professional 2 - Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Personal 3 - Name

First NameLast Name
Personal 3 - Position
Personal 3 - Years Known
Personal 3 - Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Personal 3 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Relative 4 - Name

First NameLast Name
Relative 4 - Position
Relative 4 - Years Known
Relative 4 - Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Relative 4 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Professional 1 - City
Professional 1 - State
Professional 1 - Zip
Professional 2 - City
Acknowledgement and Release Authorization
Application Acknowledgement Signature
Date

MonthDayYear
Date
Last Name
First Name
Middle Name
Government-Issued ID Number
Maiden and/or Other Name Used
State-Issued Driver’s License Number
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
County
Date of Birth

MonthDayYear
Date
Sex
Applicant’s Signature
Previous Addresses for Past Seven Years
Previous Address Details
Should be Empty:

Uniontown YMCA Employment Application

Applicant Information

Eligibility and Availability

Education and Background

Employment History

References

Acknowledgement and Release Authorization