Warren County YMCA

First Name*

Middle Initial

Last Name*

Street Address*

Apartment/Unit#

City*

State*

Zip*

Primary Phone*

Alternate Phone

Email*

Date Available*

Are you over 18?*

YES NO

Position Applied for*

If you are applying to more than one position please list here

What days are you available to work?

Weekend Availability?

YES NO

Evening Availability?

YES NO

Resume Upload (optional)

Are you a citizen of the United States*

YES NO

If no, are you authorized to work in the U.S.*

YES NO

Have you ever worked for the Warren County YMCA*

YES NO

If yes, when?

Were you referred*

YES NO

By whom?

Are you presently employed?*

YES NO

Where did you hear about this position?

Education

High School*

City/State*

From (Year)

To (Year)

Did you graduate?

YES NO Still Attending

College

City/State

From (Year)

To (Year)

Did you graduate?

YES NO Still Attending

Degree

Other

City/State

From (Year)

To (Year)

Did you graduate?

YES NO Still Attending

Degree

References

Reference 1

Full Name*

Relationship*

Company*

Phone*

Email*

Reference 2

Full Name*

Relationship*

Company*

Phone*

Email*

Reference 3

Full Name*

Relationship*

Company*

Phone*

Email*

Previous Employment

Most Recent Employer

Company

Phone

Address

Supervisor

Job Title

Responsibilities

From mm/yyyy

To mm/yyyy

Reason for leaving

May we contact your previous supervisor for a reference?*

YES NO

Company 2

Company

Phone

Address

Supervisor

Job Title

Responsibilities

From mm/yyyy

To mm/yyyy

Reason for leaving

May we contact your previous supervisor for a reference?*

YES NO

Company 3

Company

Phone

Address

Supervisor

Job Title

Responsibilities

From mm/yyyy

To mm/yyyy

Reason for leaving

May we contact your previous supervisor for a reference?*

YES NO

Military Service

Branch

From

Rank at Discharge

Type of Discharge

If other than honorable, explain

Disclaimer and Signature

We are an equal opportunity employer. Applicants for all job openings are welcome and will be considered without regard to race, color, religion, national origin, sex, age, sexual orientation, physical or mental disability, or any other basis protected by state, federal or local law. It is the intent of the YMCA to comply with all applicable federal, state and local legislation concerning equal opportunity in employment.

Pre-Employment Certification

I understand that this application is only valid for the position applied for at present and that the Warren County YMCA is not obligated to retain or consider this application for future openings.

Initial

I authorize investigation of all statements contained in this application. I understand that falsification, misrepresentation or omission of facts called for will result in immediate termination from employment or removal of my application for consideration. I authorize the Warren County YMCA to secure information about my experience with former employers, education institutions and agencies, and for those parties to provide information concerning my experience releasing all parties from any liability arising there from.

Initial

If employed by the Warren County YMCA, I will abide by the policies and rules. I understand that I will be required to possess a current and valid driver’s license if my position requires me to drive in the course of my work.

Initial

IIf selected for employment, I understand that I will be required to obtain Child Abuse, Criminal History, FBI Fingerprint, and National Sex Offender Registry Clearances at personal cost, reimbursable upon request at 6 months of positive employment.

Initial

If I am employed by the Warren County YMCA, I understand my employment can be terminated, with or without cause and with or without notice, at any time at the option of the YMCA or myself. I understand that, other than the CEO of the YMCA, no manager, supervisor or representative of the YMCA has the authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. Only the CEO of the YMCA has the authority to make any agreement contrary to the foregoing and then only in writing. I further expressly agree that, with respect to the at-will employment relationship, this constitutes full, complete and final expression of the parties’ intent concerning the nature of any employment relationship between myself and the YMCA.

Initial

My signature below certifies that I have read and understand the foregoing and to the best of my knowledge and belief, the information on this form is true and correct. My signature below also certifies that I agree to be bound by the terms and conditions stated in this application. This application contains all the understandings and agreements between me and the Warren County YMCA concerning the nature of my employment, if any, by the YMCA and supersedes all prior and/or contemporaneous practices, oral or written, agreements, understandings, statements, representations and promises, express or implied, between me and the YMCA. I understand and agree that except as noted above, no person who is either an agent or employee of the YMCA may modify, delete, vary or contradict, whether orally or in writing, the terms and conditions set forth herein.

Initial

Full Legal Name

Verification Code

Warren County YMCA

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