Employment Application Form Page 2
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4YWCA Executive Director/CEO Search Guide
64
Work Experience / Employment Essentials
1. EMPLOYMENT
NAME OF
LOCATION:
SALARY:
CONTACT:
Name/Phone to
DATES:
ORGANIZATION:
verify employment:
TITLE:
MAJOR RESPONSIBILITIES:
(leave blank if described on resume)
2. EMPLOYMENT
NAME OF ORGANIZATION
LOCATION
SALARY
CONTACT
Name/Phone to
DATES:
verify employment:
TITLE:
MAJOR RESPONSIBILITIES:
(leave blank if described on resume)
3. EMPLOYMENT
NAME OF ORGANIZATION
LOCATION
SALARY
CONTACT
Name/Phone to
DATES:
verify employment:
TITLE:
MAJOR RESPONSIBILITIES:
(leave blank if described on resume)
1. Have you ever been a member of, worked or served as a volunteer at a YWCA?
Yes
No
If yes, please elaborate:
2. Do you have a valid driver’s license or consistently reliable way to get to work and, if required, to frequent off-site
appointments?
Yes
No
3. Have you ever been in the U.S Armed Forces?
Yes
No
4. Are you now a member of the U.S. National Guard?
Yes
No
5. If appointed, are you willing to submit to a controlled substance test?
Yes
No
6. Are you able to perform the essential functions of this position, either with or without reasonable accommodation?
Yes
No
7. Have you ever been convicted of a crime?
Yes
No
If yes, explain conviction(s), how recently such offense(s) was/were committed, and disposition of the case:
YWCA Executive Director/CEO Search Guide
65
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