Employment Application Form

Your Information
Position you are applying for*:
At which YMCA branch are you applying for? (cmd or ctrl click to select multiple):
First Name*:
Last Name*:
Phone (Home)*:
Email*:
Address*:
Apt/Suite #:
City*:
State*:
ZIP Code*:
Type of Employment (ctrl or cmd + click to select multiple answers):
Days and hours available*:
How were you referred to the YMCA? (ctrl or cmd + click to select multiple answers):
YMCA employee referred by:
Have you ever applied to the Butler County Family YMCA?*:
If yes enter dates :
Have you ever been employed by the Butler County Family YMCA?*:
If yes enter dates:
Have you previously worked for any YMCA?*:
If yes enter date(s) and location:
Are you legally eligible for employment in this country?*:
Are you 18 years of age or older?*:
If No, are you 16 years of age or older?:
Other names used during prior employment?
Have you failed to be re-employed, ever been involuntarily discharged or asked to resign a position?*:
If yes please provide date(s) and circumstances.:
Have you ever been convicted of a crime?:
If yes provide date(s) and circumstances.* Conviction will NOT necessarily be a bar to employment. Each instance and explanation will be considered in relation to the position for which you are applying:
Educational Background*
Please include school(s) attended, degree/diploma earned and field of study (if applicable):
Employment History*
Please list employer name, address, phone number, job title, immediate supervisor, and dates employed:
Certifications
Please list certifications, special accomplishments, special trainings, etc.:
References*
Please list name and telephone number of 2 work references and 1 personal reference. If not applicable, list 3 school or personal references.:
Attach Resume File:

AN EQUAL OPPORTUNITY EMPLOYER

The Butler County Family YMCA is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, veteran status or any other status protected under local, state or federal laws.

By checking this box you are confirming you have read, understand, and agree to the above.

PLEASE READ CAREFULLY BEFORE SUBMITTING

I hereby certify that the information provided on this application is accurate to the best of my knowledge and subject to verification by the YMCA. I authorize the schools, persons, previous employers, agencies and other organizations names in this application to provide the YMCA (its authorized employees, agents 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 may be a justification for refusal of employment. I also understand that, if employed, any misrepresentation made by me completing this application shall be considered as sufficient cause for my dismissal without advance notice. 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 if offered a position with the Butler County Family YMCA, I may be required to submit to a pre-employment medical examination, drug/alcohol screening, and background check as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these tests/checks will result in withdrawal of any employment offer or termination of employment if already employed. I understand that completion of this form does not guarantee me status as an applicant or any consideration for employment unless I meet all stated minimum qualifications required of the position for which I am asking to be considered.

By checking this box you are confirming you have read, understand, and agree to the terms and conditions.

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