Employment Application Form (Page 4 of 4) in pdf

CONDITIONS OF EMPLOYMENT

(Please Read Carefully Before Signing)

I hereby certify that the information on this application is accurate to the best of my knowledge and is subject to verification by the YMCA. I

authorize the schools, persons, previous employers, agencies and other organizations named in this application to provide the YMCA (its

authorized employees, designees or representatives) with any relevant information that may be required to arrive at an employment decision

and hereby release any such schools, persons, employers, agencies and organizations from any and all liability which they might otherwise

incur as a result. I understand that any misrepresentation or omission of a material fact on my application in connection with employment will

be grounds for refusal of employment or for immediate termination regardless of when such information is discovered.

In the event I am employed, I understand that all employees of the YMCA are employees at will without a fixed term of employment. Any of the

YMCA’s policies, procedures or benefits can be changed, interpreted, withdrawn or added to at any time, without any prior notice. I will

familiarize myself promptly with such rules and regulations and will abide and be bound by the rules and regulations now or hereafter in effect.

Any job applicant considered “otherwise qualified” for employment will be required to undergo a drug test designed to test for the use of

controlled substances. I agree to allow the YMCA or its designees to collect urine and/or blood samples from me to determine the presence of

drugs in my body. I also give permission for release of the test results to the appropriate individuals at the YMCA and their designated medical

or professional representatives. I further authorize the release to the YMCA and its representatives any and all medical records relevant to

evaluating my drug test results. If I refuse the drug test, I understand that I cannot be considered for employment.

I further authorize the YMCA to obtain the services of an outside laboratory to conduct tests. I release the YMCA, its employees and

designated medical or professional representatives from any and all claims or causes of action resulting from the reliability of the test results,

the release of the test results, and any YMCA decision influenced by the test results.

I authorize the YMCA to supply my employment record, in whole or in part, and in confidence, to any prospective employer, government

agency, or other party, with a legal and proper interest.

I understand that as a condition of employment my driving record, criminal history record, reference checks, drug screening test and other

documents required by law must be completed, and information given by me must be verified.

I understand and agree that an offer of employment, and my continued employment with the YMCA, are contingent upon satisfactory proof of

my authorization to work in the United States.

Employees of the YMCA who drive company-owned, leased or other vehicles on company business must possess a valid North Carolina Driver’s

License. The driver’s license must not restrict driving in any manner that conflicts with job requirements. An unsatisfactory driving record may

result in the loss or restriction of driving privileges on company business which could cause termination of your employment.

This application and any material accompanying it shall become the sole property of the YMCA of Northwest North Carolina.

Finally, my signature certifies that the statements made on this application are correct and complete and in addition, I authorize the YMCA to

initiate an investigation as outlined above.

_______________________________________________________________________________________________

_____________________________

Signature of Applicant (In Ink)

Date

THE YMCA IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER.

Our Mission: Helping people reach their God-given potential in spirit, mind and body.

Revised: December 2010

Employment Application Form Page 4