Employment Application

Thank you for your interest in the YMCA!

The YMCA is an equal opportunity employer and does not discriminate in recruitment, hiring or other terms or conditions of employment on the basis of race, color, religion, national origin, sex, disability, age or any other status protected by law.

If you would like to apply to join the YMCA staff team, please complete the application below.

Be sure to write legibly
The application must be completed in full.
Do not leave any spaces blank or write “see resume” in response to any question.
Read and sign the last page of the application.

YMCA of Bristol · 400 MLK Jr. Blvd · Bristol, TN 37620 · P 423 968 3133 · F 423 968 3618 · W bristolymca.net

Personal Information

Name: Last, First, MI: Blank on the original form
E-mail:: Blank on the original form
Address: Street, City, State, ZIP: Blank on the original form
Telephone: Cell: Blank on the original form
Telephone: Home: Blank on the original form
Position Applying For:: Blank on the original form
Date:: Blank on the original form
Date Available:: Blank on the original form
Salary Desired:: Blank on the original form

Are you 18 years of age or older? (If not, you may be required to provide work authorization.)

If hired, can you provide verification of your legal right to work in the United States?

Can you perform the essential functions of the job for which you are applying, with or without reasonable accommodation?

Have you ever been convicted of a crime, pled no contest, or had adjudication withheld? If yes, please provide a date, location, charges and a complete explanation of all offenses. (A conviction will not necessarily bar employment. The YMCA may consider the nature, date and circumstances of the offenses.)

If yes, please provide a date, location, charges and a complete explanation of all offenses.: Blank on the original form

Notice to All Applicants: The YMCA enforces its policies and practices to prevent child abuse.

Allegations or suspicions of child abuse are taken very seriously at the YMCA and will be reported to the proper authorities for investigation. We have abuse reporting procedures, there are unscheduled visits from supervisors, we have an open door for parents, and we have a code of conduct for staff. We minimize opportunities for abuse to occur and we talk with children about personal safety and touching limits. We also screen carefully to prevent abusers from being hired and we provide child abuse prevention training to staff.

Employment Application

Employment Information

List available days/hours:

Sunday: Blank on the original form
Monday: Blank on the original form
Tuesday: Blank on the original form
Wednesday: Blank on the original form
Thursday: Blank on the original form
Friday: Blank on the original form
Saturday: Blank on the original form

Preferred Job Status:

Full-time
Part-time
Seasonal
As Needed

Have you previously been employed by this YMCA or any other YMCA?

If yes, when? At which locations?: Blank on the original form

Have you previously volunteered at this YMCA or any other YMCA?

If yes, when? At which locations?: Blank on the original form

Do you have any relatives or household members currently working for this YMCA?

If yes, name(s) and relationship:: Blank on the original form

How did you hear about this opening?

YMCA staff referral
YMCA member
School
Advertisement
Walk-in
Other
YMCA website

Name of referral source:: Blank on the original form

Education & Training

Educational Background

High School / GED

Name of School: Blank on the original form
City, State: Blank on the original form
Diploma Awarded — Yes / No / In Progress: Blank on the original form
Degree: Blank on the original form
Major: Blank on the original form

College

Name of School: Blank on the original form
City, State: Blank on the original form
Diploma Awarded — Yes / No / In Progress: Blank on the original form
Degree: Blank on the original form
Major: Blank on the original form

Graduate School

Name of School: Blank on the original form
City, State: Blank on the original form
Diploma Awarded — Yes / No / In Progress: Blank on the original form
Degree: Blank on the original form
Major: Blank on the original form

Vocational/Other

Name of School: Blank on the original form
City, State: Blank on the original form
Diploma Awarded — Yes / No / In Progress: Blank on the original form
Degree: Blank on the original form
Major: Blank on the original form

Describe any non-employment experience such as school or volunteer activities that might strengthen your application:: Blank on the original form
What other business experience, personal experience or training have you had that may have prepared you for this position?: Blank on the original form

Safety & Job Specific Certifications

Certification 1

Type (CPR, First Aid, CDA, etc.): Blank on the original form
Provider: Blank on the original form
Level: Blank on the original form
Expiration: Blank on the original form

Certification 2

Type (CPR, First Aid, CDA, etc.): Blank on the original form
Provider: Blank on the original form
Level: Blank on the original form
Expiration: Blank on the original form

Certification 3

Type (CPR, First Aid, CDA, etc.): Blank on the original form
Provider: Blank on the original form
Level: Blank on the original form
Expiration: Blank on the original form

The Y: We’re for youth development, healthy living, and social responsibility.

Employment Application

Employment History

List all previous employment during the past seven years starting with the most recent. Use additional sheets if needed.

Employment record 1

Employer: Blank on the original form
Telephone: Blank on the original form
Address: Blank on the original form
Job Title: Blank on the original form
Immediate Supervisor and Title: Blank on the original form
Reason for Leaving: Blank on the original form
May we contact this employer? — Yes / No: Blank on the original form
Dates Employed — From / To: Blank on the original form
Starting Hourly Rate/Salary — $ per: Blank on the original form
Ending Hourly Rate/Salary — $ per: Blank on the original form
Summarize the nature of the work performed and job responsibilities.: Blank on the original form

Employment record 2

Employer: Blank on the original form
Telephone: Blank on the original form
Address: Blank on the original form
Job Title: Blank on the original form
Immediate Supervisor and Title: Blank on the original form
Reason for Leaving: Blank on the original form
May we contact this employer? — Yes / No: Blank on the original form
Dates Employed — From / To: Blank on the original form
Starting Hourly Rate/Salary — $ per: Blank on the original form
Ending Hourly Rate/Salary — $ per: Blank on the original form
Summarize the nature of the work performed and job responsibilities.: Blank on the original form

Employment record 3

Employer: Blank on the original form
Telephone: Blank on the original form
Address: Blank on the original form
Job Title: Blank on the original form
Immediate Supervisor and Title: Blank on the original form
Reason for Leaving: Blank on the original form
May we contact this employer? — Yes / No: Blank on the original form
Dates Employed — From / To: Blank on the original form
Starting Hourly Rate/Salary — $ per: Blank on the original form
Ending Hourly Rate/Salary — $ per: Blank on the original form
Summarize the nature of the work performed and job responsibilities.: Blank on the original form

Employment record 4

Employer: Blank on the original form
Telephone: Blank on the original form
Address: Blank on the original form
Job Title: Blank on the original form
Immediate Supervisor and Title: Blank on the original form
Reason for Leaving: Blank on the original form
May we contact this employer? — Yes / No: Blank on the original form
Dates Employed — From / To: Blank on the original form
Starting Hourly Rate/Salary — $ per: Blank on the original form
Ending Hourly Rate/Salary — $ per: Blank on the original form
Summarize the nature of the work performed and job responsibilities.: Blank on the original form

Please explain any gaps in your employment history:: Blank on the original form
Are You currently Employed? — Yes / No: Blank on the original form
List any Military Experience:: Blank on the original form

The Y: We’re for youth development, healthy living, and social responsibility.

Employment Application

Personal References

Do not list relatives.

Reference 1

Name:: Blank on the original form
Occupation:: Blank on the original form
Years Known:: Blank on the original form
Address:: Blank on the original form
City:: Blank on the original form
State:: Blank on the original form
Zip:: Blank on the original form
E-mail:: Blank on the original form
Phone:: Blank on the original form

Reference 2

Name:: Blank on the original form
Occupation:: Blank on the original form
Years Known:: Blank on the original form
Address:: Blank on the original form
City:: Blank on the original form
State:: Blank on the original form
Zip:: Blank on the original form
E-mail:: Blank on the original form
Phone:: Blank on the original form

Reference 3

Name:: Blank on the original form
Occupation:: Blank on the original form
Years Known:: Blank on the original form
Address:: Blank on the original form
City:: Blank on the original form
State:: Blank on the original form
Zip:: Blank on the original form
E-mail:: Blank on the original form
Phone:: Blank on the original form

Application Acknowledgement and Authorization

Please read all statements and sign below:

I authorize both the YMCA and persons listed (references, schools, current (unless noted) and former employers and any others with whom you desire to check) to communicate with regard to any relevant information that may be required to reach an employment decision. I agree to hold such persons harmless with respect to any information they may supply. I understand and agree that any offer of employment is contingent upon successful completion of all background check processes, including a criminal history background check.

I certify that all information provided by me in this application is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation, or omission of any facts in this application or any other document submitted in connection with YMCA employment will result in denial of employment or termination of employment regardless of the timing or circumstances of discovery.

If I am employed by the YMCA I understand my employment can be terminated, with or without cause and with or without notice, at any time at the option of the YMCA or myself. I understand that, other than the CEO of the YMCA, no manager, supervisor or representative of the YMCA has authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. Only the CEO of the YMCA has the authority to make any agreement contrary to the foregoing and then only in writing. I further expressly agree that, with respect to the at-will employment relationship, this constitutes the full, complete and final expression of the parties’ intent concerning the nature of any employment relationship between myself and the YMCA.

I understand that all offers of employment are conditional upon my ability to provide appropriate documents regarding my identity and legal right to work in the United States. I understand that this application is only valid for the position applied for at present and that the YMCA is not obligated to retain or consider this application for future openings. If hired, I agree to abide by YMCA policies and rules at all times. I acknowledge that I have read the above statements and understand them.

Signature:: Blank on the original form
Date:: Blank on the original form

The Y: We’re for youth development, healthy living, and social responsibility.

Employment Application — Reading Copy