Employment Application Form
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4PLEASE READ BEFORE COMPLETING THIS EMPLOYMENT APPLICATION
The YMCA of Northwest North Carolina (the “YMCA”) does not discriminate in the recruitment, hiring, and conditions of employment on the basis of race,
color, religion, national origin, sex, marital status, disability, age or veteran status. No question on this application is intended to secure information to be
used in a discriminatory manner. Your completed application will be reviewed carefully, but its receipt does not imply that you will be employed. Employment
consideration necessitates that you meet all minimum qualifications required for the position for which you are applying. This YMCA is committed to the goal
of operating a drug-free work environment. Consistent with this goal, we have implemented a comprehensive Substance Abuse Policy which contains
provisions for testing for the use of controlled substances. ANY JOB APPLICANT CONSIDERED “OTHERWISE QUALIFIED” FOR EMPLOYMENT WILL BE
REQUIRED TO UNDERGO A PRE-EMPLOYMENT DRUG TEST DESIGNED TO TEST FOR THE USE OF CONTROLLED SUBSTANCES. IN ADDITION, A
CRIMINAL RECORD CHECK WILL BE CONDUCTED ON ALL APPLICANTS, AND WHERE APPLICABLE, A DEPARTMENT OF MOTOR VEHICLE RECORD
CHECK.
ANSWER ALL QUESTIONS COMPLETELY AND PLEASE PRINT (In Ink)
PERSONAL DATA
Name: ____________________________________________________________________________________________
Last
First
Middle
Address: _________________________________________________________________________________________
Street
_________________________________________________________________________________________
How Long? _____________
City
State
Zip
Phone No.: (________)___________________________ Email: _________________________________________
Permanent
Address (if different): ___________________________________________________________________________________________________________
Street
City
State
Zip
GENERAL INFORMATION
Position(s) Applied For: 1. ___________________________________ 2. _____________________________________
Date Available: _________________________
How were you referred to the YMCA?
Employee
Newspaper Advertisement
Website
Other:
___________________________________________________
_
Name of referral sources indicated above ________________________________________________________________________________
Have you ever been employed with the YMCA before?
Yes
No
If YES, state when and where: _______________________________________________________________
Are you looking for:
Full-time
Part-time
Seasonal/Temporary Salary Requirements: $ ____________
Do you have relatives employed at any YMCA location?
Yes
No
If YES, Name: ___________________________________ Location: ____________________________ Relationship: ____________________
Are you age 18 or above?
Yes
No
Please circle days/indicate hours you are available to work: M T W Th F S Su
From: _________ To: __________
Are you a US Citizen?
Yes
No
If no, please state the type of US employment authorization you have: ______________________________________________
Have you EVER HAD ANY FELONY convictions?
Yes
No
If YES, explain: ________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
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