Employment Application - YMCA of the Northwoods

Name *

First

Middle

Last

Daytime Telephone *

Evening Telephone

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Social Security # (required to complete background check) *

Are you legally authorized to work in the U.S? (If hired, you will be required to provide proof of work authorization) *

Yes
No

Are you at least 18 years? *

Yes
No

Date of Birth (if under 18)

If not, your employment will be subject to verification that you meet state/federal minimum age requirements for the type of work applying for.

Are there other names under which you have worked or attended school? *

Yes
No

If yes, please list for reference checking purpose

Have you ever been convicted of a crime or are any charges pending (felony or misdemeanor)? *

Yes
No

If yes, explain 1) nature of crime, 2) date of conviction, and 3) state in which convicted.

(Convictions are not an automatic bar to employment. However, failure to provide complete and accurate information relating to any criminal convictions will result in no offer of employment or immediate termination. Employment is contingent upon the results of a criminal record check.)

Position Applying For *

Position Applying For (2nd Choice)

Part Time or Full Time *

Full Time
Part Time
Either

Salary Preference

Shift Preference *

Morning
Afternoon
Evening
Any

When can you start? *

How did you hear about the job? *

If referred please list.

First

Last

Have you been paid to work for the YMCA of the Northwoods before? *

Yes
No

List any relatives working for us, and their relationship to you.

List any Certification: (Proof of certification may be required prior to employment)

Briefly describe what makes you feel qualified to be selected to fill the position you are applying for.

Name of High School *

Did you graduate? *

Yes
No

Name of College

Degree or Area of Study

Did you graduate?

Yes
No

Name of Post Graduate

Degree or Area of Study

Did you graduate?

Yes
No

Name of Trade/Tech/Business Program

Degree or Area of Study

Did you graduate?

Yes
No

Work History: Name of Employer *

Phone *

Job Title *

Supervisor *

First

Last

Start Date *

End Date *

Work History: Name of Employer (2nd)

Phone

Job Title

Supervisor

First

Last

Start Date

End Date

Work History: Name of Employer (3rd)

Phone

Job Title

Supervisor

First

Last

Start Date

End Date

Have you served in the United States armed forces? *

Yes
No

If yes what branch and what was your rank?

Start Date of Service

End Date of Service

EMPLOYMENT REFERENCES (List individuals familiar with your job qualifications–no relatives or friends) *

First

Last

Relationship *

Phone *

EMPLOYMENT REFERENCES (List individuals familiar with your job qualifications–no relatives or friends) *

First

Last

Relationship *

Phone *

EMPLOYMENT REFERENCES (List individuals familiar with your job qualifications–no relatives or friends) *

First

Last

Phone *

Relationship *