Fillable Printable YMCA Application Form

YMCA Application Form

YMCA OF GREATER PROVIDENCE

APPLICATION FOR EMPLOYMENT

The YMCA of Greater Providence is committed to providing equal employment opportunity in all employment

practices. We prohibit unlawful discrimination based on race, color, religion, creed, sex, sexual orientation, age,

national origin, physical or mental disability, ancestry, gender identity or expression, or any other class protected by

federal, state, or local laws. The questions on this application are not intended to elicit information regarding

membership in any protected class. The YMCA will make reasonable accommodations to enable a qualified

individual with a disability to perform the essential functions of his or her job.

Please circle how you learned about the position for which you are applying:

YMCA Employee:

Walk in Newspaper ad Internet posting

YMCA Member/Volunteer Job Fair College Recruiting

Have you ever submitted an employment application to any branch of the YMCA of Greater Providence?

О yes О no If yes, when? _____________________________________________

Have you previously been employed by any branch of the YMCA of Greater Providence? О yes О no

Have you previously been employed by any YMCA? О yes О no

Do you have any relatives who are employed by any branch of the YMCA of Greater Providence?

О yes О no If yes, name? _________________________________________________

Will you need reasonable accommodations to participate in the selection procedures (i.e. job interview, written testing,

or job demonstration) or to perform the essential functions of the job for which you are applying??

О yes О no О unsure

Today’s Date: _____/_____/_______

Name:

First Middle Last

Position for which you are applying:

YMCA Branch Location:

Circle your availability: Part-Time Full-time Temporary Seasonal

Your address:

E-Mail Address:

Home or Cell Phone Number:

Are you at least eighteen (18) years of age? О yes О no

Are you authorized to work in the United States? О yes О no О unsure

***By law, an I-9 form must be completed by you within 72 hours of commencement of employment. ***

EMPLOYMENT HISTORY

Please give accurate and complete information about your employment record. Start with your most recent employment.

Any work performed on a volunteer basis (that can be verified) may also be included.

Present or Last

Employer

Employer Address

From: Supervisor Phone: Last Rate of

Pay:

To: Duties Reason for Leaving

Next Previous

Employer

Employer Address

From: Supervisor Phone: Last Rate of

Pay:

To: Duties Reason for Leaving

Next Previous

Employer

Employer Address

From: Supervisor Phone: Last Rate of

Pay:

To: Duties Reason for Leaving

EDUCATION

Name and Location of School Major/Concentration Years completed or degree received

High School

College/University

Graduate School

Other

CERTIFICATIONS, TRAINING, AND ADDITIONAL SKILLS

Certification, training, or

skill (including foreign

language proficiency)

Description

Certification/License #

Expiration Date (if

applicable)

MILITARY SERVICE

REFERENCES

Please provide three references. If you have never been employed or have not had three employers, you may

list personal, non-family references. Examples of personal references could be a teacher, neighbor, coach,

clergyman or family friend.

Name Phone Number/Email Relationship

CRIMINAL RECORD

PLEASE BE ADVISED: The YMCA of Greater Providence is authorized to, and will confirm the information

requested below. NOTE for Massachusetts area applicants: It is unlawful in the Commonwealth of Massachusetts to

require or administer lie detector tests as a condition of employment. Please seek clarification with appropriate legal or

court resources if you are unsure about how to answer any of these questions

A conviction record will not necessarily be a bar to employment. An applicant for employment with a sealed record on

file with the Commissioner of Probation may answer "no record" with respect to any inquiry above relative to prior

arrests, criminal court appearances or convictions. An applicant for employment may answer “No” if his or her

criminal record consists only of one or more of the following: (1) an arrest, detention, or disposition regarding any

violation of law in which no conviction resulted; or (2) a case of delinquency or a child in need of services, which does

not result in a complaint transferred to the superior court for criminal prosecution..

1. Have you ever been convicted of a felony? О yes О no О no record

If yes, list nature of offense, dates of conviction, and dates of any incarceration associated therewith:

2. Have you been convicted of a misdemeanor? О yes О no О no record

If yes, please list the nature of the offense, date of conviction, and dates of incarceration associated therewith. You may

answer “No” if your criminal record consists of one or more of the following: (1) Any misdemeanor conviction where

the date of conviction or completion of incarceration occurred 5 or more years before the date of this application, unless

you were convicted of another offense during the past 5 years; or (2) A first conviction for drunkenness, simple assault,

speeding, minor traffic offenses, disturbance of the peace, or affray.

Branch:___________________ Rank at Discharge________________ Discharge Date____________

Describe your training, type of work done, and related skills associated with your military service:

_____________________________________

STATEMENT FROM APPLICANT

Pre-Employment Background Review

In order to ensure that the YMCA of Greater Providence employs high quality staff, I understand that as part of the

application process, an extensive inquiry will be made concerning my background, prior employment, activities, and

character. I authorize the YMCA to request my employment record from any former employer(s). I waive any right to

claim that such inquiries are an invasion of my privacy, since I am acknowledging that they will be made with my

consent. I understand that pre-employment inquiries will also include an examination of my conviction/criminal history

as well as any information in my background related to child abuse. I fully authorize and consent to such inquiries.

Employee Conduct Expectations

As an applicant, I understand that if I become an employee of the YMCA of Greater Providence, I am obligated to

comply with all policies and practices described in the Employee Handbook as well as other policies and practices

described by my supervisor related to my job. I understand that during my employment, should the YMCA learn that I

have engaged in or am engaging in possible criminal activity, including, but not limited to, concerns regarding child

abuse, the YMCA will take the concerns very seriously. Illegal or otherwise problematic off-duty conduct on the part

of an employee that unfavorably affects the Association's interests or the employee's ability to

perform his or her job will not be tolerated. I understand and acknowledge that the YMCA may be obligated to

investigate and/or communicate these concerns to certain third parties, including, but not limited to the proper

authorities, agencies, and other concerned parties. I understand that YMCA employees and volunteers cannot fraternize

with YMCA youth members or participants outside of YMCA programs, including, but not limited to, babysitting or

inviting children off the YMCA premises.

I certify that all statements made by me on this application are true and complete to the best of my knowledge. I

understand that any misrepresentation or omission of facts will exclude my being considered for employment. I

understand that if the YMCA discovers that I have falsified, omitted, or misrepresented any statements on this

application after I become employed, it may be grounds for immediate termination of employment.

I understand that if hired, employees of the YMCA are employed on an at-will basis. Employment may be terminated at

any time by either the employee or the YMCA for any reason not expressly prohibited by law.

I hereby acknowledge that I have read and understood, and voluntarily agree to all information described in this

application for employment.

______________________________

Print Name

_______________________________ ________________________

Signature of Applicant Date