YMCA Employment Application Form

Metro Atlanta YMCA Application For Employment

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodations to the application and/or interview process should notify a representative of the YMCA.

Position(s) applied for (required)

Date of application

Name
	Last	First	Middle

Address
	Street	City	State	Zip

Telelphone #

Alternate Phone #

E-mail Address

Referral Source (How did you hear about us?)

If you are under 18, and it is required, can you furnish a work permit?	Yes No
If no, please explain

Have you ever been employed here before?	Yes No
If yes, give dates and positions

Are you legally eligible for employment in this country?	Yes No
Date available for work	What is your desired salary range?

Type of employment desired

Full-Time

Part-Time

Temporary

Seasonal

Educational Co-Op

Driver's license number if driving may be required in position for which you are applying

State

Answering “yes” to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
Have you ever pled “guilty” or “no contest” to or been convicted of a crime?	Yes No
If yes, please provide date(s) and details

Employment History
Starting with your most recent employer, provide the following information.

Employer	Telephone #

	month / year		month / year
Dates Employed	/	to	/

Street Address City State

Compensation (Final)

Starting job title/final job title

Hourly Salary

$ per

Immediate supervisor and title (for most recent position held)	May we contact for reference?
	Yes No Later

Commission/Bonus/Other Compensation $

Why did you leave?

Summarize the type of work performed and job responsibilities.

Employer	Telephone #

	month / year		month / year
Dates Employed	/	to	/

Street Address City State

Compensation (Final)

Starting job title/final job title

Hourly Salary

$ per

Immediate supervisor and title (for most recent position held)	May we contact for reference?
	Yes No Later

Commission/Bonus/Other Compensation $

Why did you leave?

Summarize the type of work performed and job responsibilities.

Employer	Telephone #

	month / year		month / year
Dates Employed	/	to	/

Street Address City State

Compensation (Final)

Starting job title/final job title

Hourly Salary

$ per

Immediate supervisor and title (for most recent position held)	May we contact for reference?
	Yes No Later

Commission/Bonus/Other Compensation $

Why did you leave?

Summarize the type of work performed and job responsibilities.

Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying.


Computer Skills (Check appropriate boxes. Include software titles and years of experience.)

	Word Processing	Years	E-mail	Years
	Spreadsheet	Years	Internet	Years
	Presentation	Years	Other	Years

Educational Background
Starting with your most recent school attended, provide the following information.

School (include City & State)	Years Completed	Degree	Major/Minor

References

List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Name	Title	Relationship to You	Telephone	Number of Years Known

Attach a Resume

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to eliminate me from further consideration for employment, or may result in my immediate discharge from the employer’s service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of the Applicant Statement.

Signature of Applicant

Date

Affirmative Action Voluntary Information

Equal Employment Opportunity

The Board of Directors of the YMCA is committed to an open employment policy which does not discriminate against any applicant or employee with regard to federally-protected groups: age, race, color, religion, creed, national origin, gender, veteran status or disability. In addition, the YMCA adheres to all state, county and municipal EEO classifications of protected groups in all service areas that it programs in the metro Atlanta area. The YMCA’s Affirmative Action Policy and program is designated to ensure that the following are conducted in a non-discriminatory manner and adhere to local, state and federal regulations and ordinances:

Recruiting, hiring, and training for all appropriate job classifications.
Employment, promotion decisions, layoffs and terminations.
Compensation, benefits, transfers, training and tuition assistance.

This survey is to be completed by the applicant voluntarily (this is not mandatory or a part of the hiring process). Thank you for your help.

Applicant Information

Applicant's Name

Date

Address	Position Applied for
	Referral Source

Telephone #

Sex	National/Cultural Origin

Male	White Black or African American Hispanic or Latino
Female	American Indian / Alaskan Native Asian Native Hawaiian or Pacific Islander
	Two or more races Not specified