Employment Application Hopkins County Family YMCA

EMPLOYMENT APPLICATION
Position
X - Here if YES you are 18 years of age
X - Here if NO you are not 18 years of age
Applicants under 18 will require parent/guardian consent for applicable background checks.
Some YMCA positions have a minimum age requirement.
PERSONAL INFORMATION
Full Name

First NameMiddle InitialLast Name
Available to Start

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

City, State, Zip CodeState / Province

Postal / Zip Code
Email
example@example.com
2 PROFESSIONAL & 2 PERSONAL REFERENCES

Teacher; Coach; Community Leader; Club Advisor; etc.. may be used if no prior work experience

Rows	Name	Relationship	Phone Number	Years Known
1
2
3
4

EDUCATION & TRAINING

EDUCATION & TRAINING

Rows	Degree/Certification	School / Institution
1
2

EXPERIENCE & SKILLS

EXPERIENCE & SKILLS

Rows	Current / Recent Employer	Supervisor	Phone Number	Dates Employed
1

Position & Responsibilities: / Experience
No previous employment? Tell us about school, volunteer, or other relevant experience.
I certify that the information provided on this application is true and complete to the best of my knowledge. I understand that providing false or misleading information may affect my eligibility for employment.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hopkins County Family YMCA is an equal opportunity employer and considers qualified applicants without regard to legally protected status.

CODE OF ETHICS
STAFF CODE OF ETHICS
1. Staff will not verbally, physically, emotionally, or sexually abuse a child.
2. Staff will not be alone with children except with prior approval of senior leadership or in an emergency.
3. Staff will not use profanity in the presence of children, parents, participants or other staff.
4. Staff will not display intimate affection towards others in the presence of children, parents, or other participants.
5. Staff will not accept gifts of money from children, parents or other participants, nor will staff give gifts of money to children, parents and other participants.
6. Staff/volunteers will not socialize, associate, or provide services (such as babysitting, private lessons, etc.) for program participants under the age of 18 years outside of Hopkins County Family YMCA activities. There will be no exceptions unless individually approved by the CEO.
7. Staff will report any suspected abuse or neglect to Child Protective Services and law enforcement agencies as required by law.
8. Staff will treat all children, regardless of age, religion, race, ethnicity, gender, or disability with respect, compassion and kindness.
9. Staff will, at all times, portray a positive role model for children and youth by demonstrating respect, loyalty, patience, courtesy, tact, and maturity.
10. Staff will use only positive techniques of guidance and discipline, such as anticipation and prevention of potential problems, positive reinforcement and encouragement, and redirection.
11. Staff will never leave a child unsupervised in a YMCA program.
12. Staff will appear clean, neat and appropriately dressed.
13. Staff must report to work able to safely perform their assigned duties and must not report to work impaired in a manner that could compromise the safety of children, participants, or others.
14. Staff will not use tobacco products during work hours on the YMCA campus.
15. Staff will not use, possess, or be under the influence of alcohol or illegal drugs during work hours.
I have read and understand Hopkins County Family YMCA's position on the Nationwide Problem of Child Abuse and the Staff Code of Ethics. I understand that any violation of the Code of Ethics may result in termination. Being full aware of the matters contained in this Staff Code of Ethics, I still desire consideration for employment.

BACKGROUND SCREEN MINOR PARENTAL/GUARDIAN CONSENT
PARENT/GUARDIAN CONSENT FOR MINOR BACKGROUND SCREENING
This form must be completed by a parent or legal guardian and returned with a completed application*
No minor will undergo a YMCA employment background check without the required signed consent*
BACKGROUND SCREENING NOTICE
Hopkins County Family YMCA may obtain a consumer report about the minor applicant identified below from Datasource Background Screening Services, a consumer reporting agency, for employment purposes.
The screening may include criminal history information and a search of the U.S. Sex Offender Registry, as applicable to the screening process.
PARENT / GUARDIAN CONSENT
I am the parent or legal guardian of the minor applicant identified below. I consent to and authorize Hopkins County Family YMCA to obtain a consumer report concerning the minor applicant from Datasource Background Screening Services for employment purposes, including the criminal history and U.S. Sex Offender Registry screening included in the background-check process.
MINOR APPLICANT INFORMATION
Full Legal Name of Applicant Printed Here

First NameMiddle InitialLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
PARENT / LEGAL GUARDIAN INFORMATION
Full Name of Parent/Legal Guardian Printed Here

First NameLast Name
Relationship to the Minor
If an investigative consumer report is requested, the YMCA will provide the additional notice required by law

BACKGROUND SCREEN AUTHORIZATION
BACKGROUND SCREENING DISCLOSURE
BACKGROUND CHECK DISCLOSURE & AUTHORIZATION
The Hopkins County Family YMCA may obtain a background screening report about you from Datasource Background Screening Services or another consumer reporting agency selected by the YMCA for employment-related purposes.
The screening may include criminal history, sex offender registry information, employment or education verification, motor vehicle records, professional licenses, and other job-related information permitted by law.
I authorize the Hopkins County Family YMCA and its designated screening providers to obtain and review background information about me for purposes related to employment, including hiring, continued employment, promotion, transfer, or assignment, as permitted by law.
KIDS CENTER / KARES AUTHORIZATION
If I am applying for or working in the YMCA Kids Center, I understand that Kentucky-required background screening through the Kentucky Applicant Registry and Employment Screening (KARES) may be part of the YMCA's background screening process.
I authorize the Hopkins County Family YMCA to obtain, use, and maintain the applicable KARES screening information for employment-related purposes, consistent with applicable law and YMCA policy.
ACKNOWLEDGMENT
I certify that the information I provide for background screening is true and complete to the best of my knowledge. I understand that this authorization does not guarantee employment and that additional screening may be required based on the position or applicable law.
Full Legal Name Printed

First NameMiddle NameLast Name
Other Name(s) Used
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please list any other addresses where you have lived during the past 7 years.

Please list any other addresses where you have lived during the past 7 years.

Rows	Street Address	City/State/ZIP	Dates Lived There
1
2
3

AUTHORIZATION SIGNATURE
If an investigative consumer report is requested, the YMCA will provide the additional notice required by law

CHILD-DIRECT POSITIONS ONLY
Kids Center/Child Watch/Dance
COMPLETE IF APPLYING TO WORK WITH CHILDREN
Kids Center Applicants: Applicants for positions in the Hopkins County Family YMCA Kids Center are subject to additional requirements under Kentucky child-care regulations, including required background screening through the Kentucky Applicant Registry and Employment Screening (KARES) process and applicable training requirements established by the Kentucky Cabinet for Health and Family Services. Employees are responsible for completing all required training within the applicable timeframes.
Why do you want to work with and care for children?
With what age groups do you have experience working with, and what age groups are you most comfortable working with? Why?
What is your philosophy about discipline?
What do you do when you are upset or angry about something?
Other than through employment, how are you involved with children?
List the 3 greatest strengths and the 3 most difficult problems you have in working with children.
Greatest Strengths 1.
Greatest Strengths 2.
Greatest Strengths 3.
Most Difficult Problems 1.
Most Difficult Problems 2.
Most Difficult Problems 3.
Should be Empty:

EMPLOYMENT APPLICATION

PERSONAL INFORMATION

2 PROFESSIONAL & 2 PERSONAL REFERENCES

EDUCATION & TRAINING

EXPERIENCE & SKILLS

CODE OF ETHICS

STAFF CODE OF ETHICS

BACKGROUND SCREEN MINOR PARENTAL/GUARDIAN CONSENT

PARENT/GUARDIAN CONSENT FOR MINOR BACKGROUND SCREENING

MINOR APPLICANT INFORMATION

PARENT / LEGAL GUARDIAN INFORMATION

BACKGROUND SCREEN AUTHORIZATION

BACKGROUND SCREENING DISCLOSURE

AUTHORIZATION SIGNATURE

CHILD-DIRECT POSITIONS ONLY

Kids Center/Child Watch/Dance

COMPLETE IF APPLYING TO WORK WITH CHILDREN