Employment Application

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PLEASE READ BEFORE SIGNING

We appreciate your interest in a position with the Ashland Family YMCA. If you have questions about making the

following statement, please ask the interviewer to explain.

STATEMENT OF APPLICANT

In the Ashland Family YMCA’s effort to attract the highest quality staff, I have been advised that as part of the
application process for employment, an extensive inquiry will be made concerning my prior employment, activities, and character. I fully consent to and authorize all such inquiries.

In the event of my employment by the Ashland Family YMCA, I will comply with all policies set forth in the personnel

policy and with other policies established from time to time by the organization. I authorize the Ashland Family YMCA to request my employment record from any former employer(s). I further understand that inquiries or
requests may be made by the Ashland Family YMCA or its representatives to any governmental agency, including law enforcement agencies or departments, or any other party with a legal or proper interest. I hereby waive any right to claim that any request or investigation is an invasion of privacy, since they are made with my consent and it is in my interest that I be considered for employment.

I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand and agree that any misrepresentation or omission of facts would exclude my being considered for employment or, after
employment, would be cause for termination of employment with the Ashland Family YMCA.

I understand and agree that if I am employed, there is no contract period for employment and my employment would be solely “employment at will,” giving either me or the Ashland Family YMCA the right to terminate my employment at any time without liability or obligation except for my regular pay through the date of termination.

I hereby acknowledge that I have read and understand the above statements and that I voluntarily sign this application.*
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How did you hear about us?*
Name*
Home Address*
Mailing Address (If Different)
Are you 18 years or older?*
Are you legally authorized to work in the us?*
Do you possess current CPR certification?*
Are you employed now? If so, can we contact you current employer?*
Please enter the times you are available to work each day:*
Sunday
Monday
Tuesday
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Education*
Did You Graduate?*
(Please exclude names of organizations which might indicate the race, color, creed, gender, age, marital status, or national origin of its members.)

Work History

Address*
Address
Address

References

Name - Reference 1*
Name - Reference 2*
Name - Reference 3*
Emergency Contact*
Max. file size: 512 MB.

I authorize investigation on all statements contained in this application. I understand that misrepresentation of information provided is cause for dismissal. Further, I understand that my employment is for no definite period, and may, regardless of the date of payment of my wages/salary, be terminated at any time without cause and without notice.

The Federal Immigration Reform and Control Act requires individuals to provide to an employer documented proof that they are authorized to work in the United States. This proof must be provided to, and verified by, the Ashland Family YMCA at the time of hire or no later than three business days after the date of hire.

I Agree
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