Employment Application

Employment Application

YMCA of Greater Whittier

An Equal Opportunity Employer

It is the policy of the YMCA of Greater Whittier to provide employment, training, compensation, promotion and other conditions of employment without regard to race, color, religion, national origin, ancestry, sexual orientation, medical condition(cancer), HIV and AIDS, disability, veteran status, marital status, age, sex or any other consideration made unlawful by federal, state or local laws. We employ only persons legally authorized to work in the U.S.A.

- Attach your resume if you have one.

- Provide complete information.

Information you provide on this application form is subject to verification by the YMCA of Greater Whittier.

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Previous Address

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Email*

Position Applied for:

Shift Desired*

Earnings Desired

Date Available to Start Work*

How were you referred?*

If offered employment, can you submit verification of your legal right to work in the United States?*

Yes No

Do you have any relatives/friends working for the YMCA of Greater Whittier?*

Yes No

Have you ever applied to this organization before?*

Yes No

Have you ever been employed by the YMCA of Greater Whittier?*

Yes No

If yes, state which branch/dept. and period of time:

UPLOAD RESUME/COVER LETTER INCLUDING PRIOR EMPLOYMENT AND EDUCATIONAL HISTORY

Upload Resume*

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Upload Cover Letter

No File Chosen

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CERTIFICATIONS

Please include expiration date of current certificates; must submit originals upon hire.

First Aid

Yes No

First Aid Exp. Date

CPR

Yes No

CPR Exp. Date

WSI

Yes No

WSI Exp. Date

Advanced Life Saving

Yes No

Advanced Life Saving Exp. Date

Other YMCA Certification (include dates)

No. of Early Childhood Education Credits

School Age Appropriate

FOR JOBS REQUIRING DRIVING

For Jobs Requiring Driving: Do you have a valid driver's license in this state?

Yes No

For Jobs requiring Driving. Driver's License Number and Expiration Date:

For jobs requiring driving, are you 21 years of age or older?

Yes No

For jobs requiring driving, do you possess any special endorsement on your license?

Yes No

Please specify:

For jobs requiring driving, has a license, permit, or privilege to operate a motor vehicle ever been denied, suspended or revoked?

Yes No

If yes, explain:

FOR JOBS REQUIRING OFFICE MACHINE SKILLS

Office machines you operate:

Do you type:

Yes No

Speed (wpm):

Do you operate a 10-key by touch?

Yes No

Do you have word processor experience?

Yes No

If yes, list software you have used:

JOB DUTIES

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?*

Yes No

If no, describe the functions that cannot be performed:

Note: We comply with the ADA and consider reasonable accomodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)

Name of Person to be notified in case of accident or emergency:*

Phone Number of Person to be notified in case of accident or emergency:*

REFERENCES

List below three persons not related to you who have knowledge of your work performance within the last three years.

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Occupation*

Number of Years Acquainted*

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Occupation*

Number of Years Acquainted*

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Occupation*

Number of Years Acquainted*

EMPLOYMENT APPLICANT AGREEMENT

The facts set forth in my application for employment are trne and complete. I understand that no representations have been made with respect to length of any proposed employment with the YMCA of Greater Whittier. I also understand that if I am employed, any false statements on this application will be considered sufficient cause for dismissal. I hereby release the YMCA of Greater Whittier and all reference sources from all liability for any claims whatsoever resulting from any information furnished by such sources to the YMCA of Greater Whittier.

I understand that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice, with or without cause. In consideration of my employment, I agree to conform to all rnles, regulations and policies of this company. No modification of these statements shall be valid unless written and signed by the Chief Executive Officer. I understand that if hired, I will be an employee "at will". I understand that this agreement cannot be changed except in a written document signed by me and the Chief Executive Officer. I understand that if hired, this Statement is part of the employment agreement between the YMCA and me, and will be binding on me.

Signature*

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Use your mouse or finger to draw your signature above

Date/Time*

YMCA OF GREATER WHITTIER APPLICANT RELEASE FORM

PLEASE READ BEFORE SIGNING

We appreciate your interest in a position with the YMCA of Greater Whittier. If you have questions about making the following statement, please ask the interviewer to explain.

Statement of Applicant

In the YMCA of Greater Whittier's effort to attract the highest quality staff, I have been advised that as a part of the application process for employment with the YMCA of Greater Whittier, an extensive inquiry will be made concerning my prior employment, activities, character and health (where required by law), and I fully consent to and authorize all such inquiries.

In the event of my employment by the YMCA of Greater Whittier, I will comply with all policies set forth in the personnel manual and with other policies established from time to time by the organization. I understand that my initial employment is contingent upon receipt of a report of a current physical examination if required by law, made of me by a licensed physician showing me to be in good health and free of contagious diseases. Additionally, I authorize the YMCA of Greater Whittier to request my employment record from any former employer(s). I further understand that inquiries may be made, concerning me, my background, experience and prior employment. Inquiries or requests may be made by you, or your representatives, to any governmental agency, including law enforcement agencies or departments, or any other party with a legal and proper interest. I hereby waive any right to claim that any request or investigation is an invasion of my privacy, since they are made with my consent and it is in my interest that I be considered for employment.

I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand and agree that any misrepresentation or omission of facts would exclude my being considered for employment or, after employment, would be cause for termination of employment with the YMCA of Greater Whittier.

I understand and agree that if I am employed, there is no contract period for employment and my employment would be solely an "employment at will" giving either me or the YMCA of Greater Whittier the right to terminate my employment at any time without liability or obligation except for my regular pay through date of termination.

I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE ABOVE STATEMENTS AND THAT I VOLUNTARILY SIGN THIS APPLICATION.

Signature*

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Date/Time*