Ymca Of Greater Providence Application Form For Employment Page 3
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4MILITARY SERVICE
Branch:___________________ Rank at Discharge________________ Discharge Date____________
Describe your training, type of work done, and related skills associated with your military service:
REFERENCES
__
_____________________________________
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
Name
Phone Number/Email
Relationship
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.
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