EmailMe Form - YMCA of Calhoun County Employment Application

PERSONAL INFORMATION

Name *

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Email

Phone Number *

### - ### - ####

Are you under the age of 18?

Yes

No

Do you have any relatives currently employed by the YMCA of Calhoun County? *

Yes

No

Are you eligible to work in the United States? *

Yes

No

POSITION & AVAILABILITY:

What position are you applying for? *

What shifts are you available to work? *

Are you applying for a full-time or part-time position? *

Full-Time

Part-Time

May we contact your present or previous employer? *

Yes

No

What date are you available to start work? *

MM / DD / YYYY

EMPLOYMENT HISTORY:

Most Recent Position:

Employer: *

Supervisor: *

Address: *

Phone Number *

### - ### - ####

Position: *

Duties & Responsibilities *

Reason For Leaving *

End Date *

MM / DD / YYYY

Start Date *

MM / DD / YYYY

Salary *

If not salaried, input hourly rate.

Previous Position

Employer: *

Supervisor: *

Position Title: *

Address: *

Phone Number *

### - ### - ####

Duties & Responsibilities *

Reason For Leaving *

End Date *

MM / DD / YYYY

Start Date *

MM / DD / YYYY

Salary *

If not salaried, input hourly rate.

Previous Position

Employer: *

Supervisor: *

Address: *

Phone Number *

### - ### - ####

Position Title: *

Duties & Responsibilities *

Reason For Leaving *

End Date *

MM / DD / YYYY

Start Date *

MM / DD / YYYY

Salary *

If not salaried, input hourly rate.

EDUCATION:

Name and Address of School- Degree/Diploma- Graduation Date *

If none type N/A

Name and Address of School- Degree/Diploma- Graduation Date

If none, type N/A

Skills

Please list specific skills or training: What knowledge or individual experiences do you have which will be an asset to the YMCA of Calhoun County?

Skills and Qualifications: Licenses, Skills, Training, Awards *

References:
Name/Title Address Phone

References:
Name/Title Address Phone *

"I certify that information contained in this application is true and complete to the best of my knowledge and may be verified by the YMCA or its agents. I authorize all the schools, persons, and organizations named in this application to provide any information in their possession or knowledge to the agents of the YMCA, for use in deciding whether or not to offer me employment and specifically waive any required written notification. I hereby release the YMCA, my former employers and all other persons from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure. I authorize the YMCA to obtain a criminal background report for use in determining whether or not to offer me employment. I understand and agree that any misrepresentation or omission of facts, in this application, will be justification for refusal or terminating employment, regardless of the time elapsed before discovery. I understand and agree that the employment for which I am making application is, and is intended to be, at-will and such employment may be terminated at any time with or without cause, or prior notice by either myself or the YMCA. There will be no agreement, expressed or implied, between the YMCA and me for any specific period of employment, nor for continuing or long term employment, unless made in writing and signed by the President and CEO of the YMCA of Calhoun County."

By typing your name in the space below, you are stating that you have completed the entire application to the best of your ability and you have carefully read the forgoing statements. *

Yes, I agree.

Signature *

Type name for signature

Date *

MM / DD / YYYY