Employment Application Learn. Grow. Thrive.Interested in strengthening your community by becoming a part of the Y team? Fill out the application below! Personal InformationApplication must be completed in full and signed to be considered for employment.Full Name*Date* MM slash DD slash YYYY Street Address*Home PhoneCity, State, Zip*Cell Phone*E-mail Address* Are you 18 years of age or older?* Yes No Emergency Contact Name and Relationship*Emergency Phone*Previous Residence (Street Address, City, State, Zip)*What branch are you interested in?* WISE Elizabeth Five Points Child Development Center Five Points Wellness Center Rahway Youth Development Dudley House Association Office Were you previously employed at this YMCA or another YMCA?* No If YES, provide dates and name/address of YMCA Dates and Name/Address of YMCA previously employed:*Do you have any physical limitations that preclude you from performing any work you are being considered for?* No If YES, what can be done to accommodate your limitations? What can be done to accommodate your limitations?*Do you have any pending charges or ever pled guilty or been convicted of a crime, felony, disorderly persons offense, public indecency, drunk driving offense or other violation of the law? Do not include convictions that have been annulled, expunged or sealed by the court.* No If YES, please explain * Answering yes to the above question does not constitute an automatic bar from employment, but will be considered in relation to the position sought.Please explain:*Notice to Applicants The Gateway Family YMCA maintains a "ZERO TOLERANCE" for child abuse and/or substance abuse. Criminal background checks and other federal or state screenings for child abuse will be conducted. Screening tests for alcohol and illegal drug use may be required before and during employment. Our YMCA is an Equal Opportunity Employer. We consider each application without regard to age, race, gender, color, religious creed, national origins, sexual orientation, criminal record, mental illness, handicap, disability, marital status, veteran status or any other legally protected status pursuant to relevant federal, state and local laws. Reasonable accommodations will be made for applicants with disabilities and qualified new hires. Employment AvailabilityPosition applying for: Part-time Full-time Seasonal Other Position applying for: Morning Days Evenings Weekdays Weekends List Hours Available:*Restrictions to Work Hours or Days:*Salary Desired:*Date Available to Start* MM slash DD slash YYYY Notice to Applicants The Gateway Family YMCA maintains a "ZERO TOLERANCE" for child abuse and/or substance abuse. Criminal background checks and other federal or state screenings for child abuse will be conducted. Screening tests for alcohol and illegal drug use may be required before and during employment. Our YMCA is an Equal Opportunity Employer. We consider each application without regard to age, race, gender, color, religious creed, national origins, sexual orientation, criminal record, mental illness, handicap, disability, marital status, veteran status or any other legally protected status pursuant to relevant federal, state and local laws. Reasonable accommodations will be made for applicants with disabilities and qualified new hires. Employment & Volunteer HistoryProvide the following information for current and past employers or volunteer assignments, starting with the most recent (use additional boxes if necessary). A resume does not replace the completion of the YMCA Employment Application.Employer/OrganizationPhoneStreet Address, City, State, ZipJob TitleImmediate Supervisor and TitleReason For LeavingDates of Employment Month / YearFromToHourly Rate / SalaryStartFinalSummarize type of work performed and job responsibilities.Add additional employer/organization?* Yes No Employer/OrganizationPhoneStreet Address, City, State, ZipJob TitleImmediate Supervisor and TitleReason For LeavingDates of Employment Month / YearFromToHourly Rate / SalaryStartFinalSummarize type of work performed and job responsibilities.Add additional employer/organization?* Yes No Employer/OrganizationPhoneStreet Address, City, State, ZipJob TitleImmediate Supervisor and TitleReason For LeavingDates of Employment Month / YearFromToHourly Rate / SalaryStartFinalSummarize type of work performed and job responsibilities.How were you referred to our YMCA? Ad Agency Signage Walk-in Website YMCA Staff Referral Other Non-Employment RecordPlease explain any gaps in your employment history.FromToReasonAdd another gap?* Yes No FromToReasonAdd another gap?* Yes No FromToReasonNotice to Applicants The Gateway Family YMCA maintains a "ZERO TOLERANCE" for child abuse and/or substance abuse. Criminal background checks and other federal or state screenings for child abuse will be conducted. Screening tests for alcohol and illegal drug use may be required before and during employment. Our YMCA is an Equal Opportunity Employer. We consider each application without regard to age, race, gender, color, religious creed, national origins, sexual orientation, criminal record, mental illness, handicap, disability, marital status, veteran status or any other legally protected status pursuant to relevant federal, state and local laws. Reasonable accommodations will be made for applicants with disabilities and qualified new hires. EducationSchool NameMajor Course or Degree ProgramDiploma / Degree / CertificateAdd more education?* Yes No School NameMajor Course or Degree ProgramDiploma / Degree / CertificateAdd more education?* Yes No School NameMajor Course or Degree ProgramDiploma / Degree / CertificateCheck off special skills or interests: Aquatics Art Babysitting Camps CDL License Child Care Clerical Customer Service Fitness Fundraising Gymnastics Maintenance Math Music Party Planning Science Technology Youth Sports Other Do you hold current CPR certification?* Yes No ExpirationDo you hold current First Aid certification?* Yes No ExpirationDo you hold current Lifeguarding certification?* Yes No ExpirationDo you hold current AED/Oxygen certification?* Yes No ExpirationList additional current certifications:Notice to Applicants The Gateway Family YMCA maintains a "ZERO TOLERANCE" for child abuse and/or substance abuse. Criminal background checks and other federal or state screenings for child abuse will be conducted. Screening tests for alcohol and illegal drug use may be required before and during employment. Our YMCA is an Equal Opportunity Employer. We consider each application without regard to age, race, gender, color, religious creed, national origins, sexual orientation, criminal record, mental illness, handicap, disability, marital status, veteran status or any other legally protected status pursuant to relevant federal, state and local laws. Reasonable accommodations will be made for applicants with disabilities and qualified new hires. ReferencesProvide at least three professional references (employers, teachers, coaches etc.) and three personal references, who can attest to your abilities and suitability for YMCA employment. One reference must be a family member.NameStreet Address, City, State, ZipPhoneRelationshipNameStreet Address, City, State, ZipPhoneRelationshipNameStreet Address, City, State, ZipPhoneRelationshipNameStreet Address, City, State, ZipPhoneRelationshipNameStreet Address, City, State, ZipPhoneRelationshipNameStreet Address, City, State, ZipPhoneRelationshipNotice to Applicants The Gateway Family YMCA maintains a "ZERO TOLERANCE" for child abuse and/or substance abuse. Criminal background checks and other federal or state screenings for child abuse will be conducted. Screening tests for alcohol and illegal drug use may be required before and during employment. Our YMCA is an Equal Opportunity Employer. We consider each application without regard to age, race, gender, color, religious creed, national origins, sexual orientation, criminal record, mental illness, handicap, disability, marital status, veteran status or any other legally protected status pursuant to relevant federal, state and local laws. Reasonable accommodations will be made for applicants with disabilities and qualified new hires. Applicant StatementI certify that all information I have provided in order to apply for and secure work with The Gateway Family YMCA is true, complete and correct, and I understand that any information provided found to be false, incomplete or misrepresented in any respect, will be sufficient cause to cancel further consideration of this application, or result in my immediate discharge from The Gateway Family YMCA's service, whenever it is discovered.Initial*I expressly authorize, without reservation, The Gateway Family YMCA, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview, I hereby waive any and all rights and claims I may have regarding The Gateway Family YMCA, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations, organizations for furnishing such information about me. I am aware that I have the right to make a written request for disclosure of the nature and scope of any report that may be ordered.Initial*I understand upon offer of employment, The Gateway Family YMCA will conduct a criminal background check prior to and during my employment as well as a child abuse registry check and I am subject to random, accident follow-up, and for cause drug testing, as well as post offer drug screening contingent on employment.Initial*I am not a child molester, abuser or pedophile; and have not been accused of being a molester or abuser.Initial*I understand that The Gateway Family YMCA does not discriminate in hiring or employment on the basis of age, race, gender, color, religious creed, national origins, sexual orientation, criminal record, mental illness, disability, marital status, veteran status, ancestry; or on the basis of a handicap not limiting the applicant's ability to perform satisfactorily the job available. The Gateway Family YMCA will give this application every reasonable consideration. However, in accepting it, The Gateway Family YMCA makes no commitment of employment to the applicant.Initial*Employment with The Gateway Family YMCA is employment at will, which means that employees may end their employment at any time, for any reason; and that the employer (The Gateway Family YMCA) may terminate employees at any time for any reason, with or without cause.Initial*I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete a USCIS FORM I-9 in this regard. I certify that I have read, fully understand and accept all terms of the foregoing applicant statement.Signature of Applicant*Date of Application* MM slash DD slash YYYY Signature of Parent if Applicant is Under 18 Years of AgeDate MM slash DD slash YYYY Parent's NameDate MM slash DD slash YYYY Notice to Applicants The Gateway Family YMCA maintains a "ZERO TOLERANCE" for child abuse and/or substance abuse. Criminal background checks and other federal or state screenings for child abuse will be conducted. Screening tests for alcohol and illegal drug use may be required before and during employment. Our YMCA is an Equal Opportunity Employer. We consider each application without regard to age, race, gender, color, religious creed, national origins, sexual orientation, criminal record, mental illness, handicap, disability, marital status, veteran status or any other legally protected status pursuant to relevant federal, state and local laws. Reasonable accommodations will be made for applicants with disabilities and qualified new hires. PhoneThis field is for validation purposes and should be left unchanged. Δ
