Application For Employment Form Page 2
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2EMPLOYMENT HISTORY
COMPLETE ALL SECTIONS
GIVE YOUR FULL EMPLOYMENT OR VOLUNTEER HISTORY RECORD FOR THE LAST 10 YEARS. SHOW UNEMPLOYED OR SELF-EMPLOYED PERIODS.
YOU MAY USE EXTRA SHEETS FOR ADDITIONAL INFORMATION. A RESUME MAY BE USED TO SUPPLEMENT (BUT NOT REPLACE) THIS INFORMATION.
LIST CURRENT OR MOST RECENT EMPLOYER FIRST.
COMPANY NAME (CURRENT OR LAST)
TELEPHONE
POSITION TITLE
DATES EMPLOYED (MONTH/YEAR)
FROM:
TO:
ADDRESS
CITY/STATE/ZIP
TYPE OF BUSINESS
BASE RATE OF PAY
SUPERVISOR'S NAME AND TITLE
REASON FOR LEAVING
MAY WE CONTACT THIS EMPLOYER?
YES
NO
DESCRIPTION OF DUTIES
COMPANY NAME
TELEPHONE
POSITION TITLE
DATES EMPLOYED (MONTH/YEAR)
FROM:
TO:
ADDRESS
CITY/STATE/ZIP
TYPE OF BUSINESS
BASE RATE OF PAY
SUPERVISOR'S NAME AND TITLE
REASON FOR LEAVING
MAY WE CONTACT THIS EMPLOYER?
YES
NO
DESCRIPTION OF DUTIES
COMPANY NAME
TELEPHONE
POSITION TITLE
DATES EMPLOYED (MONTH/YEAR)
FROM:
TO:
ADDRESS
CITY/STATE/ZIP
TYPE OF BUSINESS
BASE RATE OF PAY
SUPERVISOR'S NAME AND TITLE
REASON FOR LEAVING
MAY WE CONTACT THIS EMPLOYER?
YES
NO
DESCRIPTION OF DUTIES
REFERENCES
2 PROFESSIONAL AND 1 RELATIVE
NAME
ADDRESS
CITY/STATE/ZIP
TELEPHONE
OCCUPATION
ACKNOWLEDGEMENT
1. I certify, under penalty of perjury, that all of the above information is true and complete
I also understand that this aspect of my employment which includes the Association’s right to
and I understand that any misrepresentation, falsification or omission of information may
demote or otherwise discipline with or without cause or notice, may not be changed, modified,
result in the denial of employment or, if hired, may result in termination.
amended or rescinded except by an individual written agreement signed by both me and the
President of the Association.
2. I authorize the Association to contact my former employers, references, and any and all
4. I acknowledge that I have read all the above statements and that I understand them. In
other persons and organizations for information bearing upon my qualifications for
addition, the statements above supersede and replace any prior understandings or
employment. I further authorize the listed employers, schools, and personal references to
discussions I have had with the Association and set forth the complete agreement between
give the Association (with or without further notice to me) any and all information about my
me and the Association regarding these matters.
previous employment and education, along with any other pertinent information they may
have. In addition I hereby release the YMCA, my former employer, and all other persons,
5. The YMCA takes seriously the protection of the children involved in its programs. To help
corporations, partnerships and associations from any and all claims demands or liabilities
assure the safety of children the YMCA follows a comprehensive hiring protocol for volunteer
arising on or any way related to such investigation or disclosure.
and paid staff, including thorough interviews and reference checks, criminal background
screening through the California Department of Justice and Federal Bureau of Investigation,
and review and acceptance of the YMCA Code of Conduct.
3. I expressly agree and understand that, if employed, my employment having no specific
As part of this protocol, questions about past abuse and/or abusive behavior will be asked
term, is based upon mutual consent and may be terminated at will, with or without cause or
of each applicant and reference. By signing this application, I agree that the information I give
notice, by either party (the Association or me).
now and as part of the hiring process shall be true, complete, and accurate.
Signature
Date
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Parent category: Business