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Walla Walla YMCA Phone: 509.525.8863 email: wwymca.org

APPLICATION FOR

EMPLOYMENTFOR YOUTH DEVELOPMENT

FOR HEALTHY LIVING

FOR SOCIAL RESPONSIBILITY

The YMCA is an organia!ion "o#n$e$ on Chris!ian %rinci%les. &n e'ery as%ec! o" o#r wor( we see( !o crea!e an en'ironmen! !ha! enco#rages

an$ %romo!es moral an$ e!hical )eha'ior. All em%loyees are e*%ec!e$ !o con!ri)#!e !o crea!ing an$ main!aining s#ch an en'ironmen!.+or !his a%%lica!ion !o )e consi$ere$, each i!em m#s! )e com%le!e$.

This associa!ion $oes no! $iscrimina!e in hiring or em%loymen! on !he )asis o" race, color, religion, gen$er, se*#al orien!a!ion, gen$er i$en!i!y,na!ional origin, age, non-o) rela!e$ me$ical con$i!ion or han$ica%, 'e!eran, mari!al s!a!#s or any o!her legally %ro!ec!e$ s!a!#s. /o #es!ion in

!his "orm is in!en$e$ !o sec#re in"orma!ion !o )e #se$ "or s#ch $iscrimina!ion. Please con!ac! 1#man eso#rces i" yo# re#ire accommo$a!ion !ocom%le!e !he a%%lica!ion or in!er'iew %rocess.

CONTACT INFORMATION:

/ame 4a!e

as! +irs! M.&.

Phoneemail

A$$ress!ree! Ci!y !a!e 7i%

POSITION APPLIED FOR:. & am a%%lying "or !he %osi!ion o" Please no!e !ha! a%%lica!ions are only acce%!e$ "or c#rren! o%enings an$ are no! (e%! on "ile "or "#!#re o%enings

2. ;m%loymen! $esire$: +#ll Time: Yes /o Par! Time: Yes /o

3. 4a!e yo# can s!ar!: alary or wage $esire$:

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EMPLOYMENT HISTORY: is! em%loymen! )eginning wi!h yo#r mos! recen! %osi!ion )elow.

/ame A$$ress o" Com%any,

Ty%e o" B#siness

+rom

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To

MoYr

!ar!ing Wage

Dr alary

;n$ing Wage

Dr alary

eason "or ea'ing #%er'isorEs /ame

4escri)e !he wor( yo# $i$:

Phone:

/ame A$$ress o" Com%any, Ty%e o" B#siness

+romMoYr

ToMoYr

!ar!ing WageDr salary

;n$ing WageDr alary

eason "or ea'ing #%er'isorEs /ame

4escri)e !he wor( yo# $i$:

Phone:

/ame A$$ress o" Com%any Ty%e o" B#siness

+romMoYr

ToMoYr

!ar!ing WageDr alary

;n$ing WageDr alary

eason "or ea'ing #%er'isorEs /ame

Phone:

. May we con!ac! !he em%loyers lis!e$ a)o'e= Yes /o &" no, %lease e*%lain why no!

2. &n a$$i!ion !o !he %osi!ions i$en!i"ie$ a)o'e, lis! any o!her a%%lica)le s(ills:a. c.

). $.

REFERENCES: is! !hree %ersonal re"erences e*cl#$ing rela!i'es or "ormer em%loyersName Address Busiess !r O""u#a$i! P%!e&

PLEASE RE'IE( THIS FORM AND MAKE SURE THAT YOU ANS(ERED EACH ITEM

PLEASE READ CAREFULLY BEFORE SIGNING:

F & a!!es! !ha! !he in"orma!ion %ro'i$e$ in !his a%%lica!ion is !r#e an$ correc! an$ agree !ha! any #n!r#!h"#l or mislea$ing answers, or omission

o" "ac!, may res#l! in reec!ion o" !his a%%lica!ion, or $ismissal i" em%loye$. & a#!horie an$ release any an$ all "ormer em%loyers, s#%er'isors,

an$ any o!her %ersons !o "#rnish !he YMCA wi!h in"orma!ion concerning my wor( %er"ormance, s(ills, a)ili!ies, an$ charac!er.

F & #n$ers!an$ !ha! i" an o""er o" em%loymen! is ma$e, em%loymen! is con$i!ional )ase$ #%on !he res#l!s o" )ac(gro#n$ in'es!iga!ions

con$#c!e$ )y !he YMCA. Bac(gro#n$ in'es!iga!ions incl#$e com%le!ion o" a criminal con'ic!ion an$ a)#see*%loi!a!ion $isclos#res an$

rela!e$ recor$s chec(. A$$i!ionally, %re'io#s wor( e*%erience, aca$emic his!ory, cer!i"ica!ions, %ro"essional licenses, e!c., may )e 'eri"ie$.F &" em%loye$, & agree !ha! em%loymen! wi!h !he YMCA is a!-will an$ !ha! ei!her !he YMCA or & may !ermina!e !he rela!ionshi% a! any!ime

wi!h or wi!ho#! ca#se or no!ice. This a!-will em%loymen! rela!ionshi% can only )e al!ere$ in wri!ing signe$ )y !he ;*ec#!i'e 4irec!or an$ me.

F As a $r#g-"ree wor(%lace & #n$ers!an$ !ha! i" o""ere$ a %osi!ion & may )e re#ire$ !o s#)mi! !o a %re-em%loymen! an$or ran$om $r#g

screening. & #n$ers!an$ !ha! #nsa!is"ac!ory res#l!s "rom, re"#sal !o coo%era!e wi!h, or any a!!em%! !o a""ec! !he res#l!s o" !es!ing will res#l! in

wi!h$rawal o" any em%loymen! o""er or !ermina!ion o" em%loymen! i" alrea$y em%loye$.

F & "#r!her #n$ers!an$ !ha!, i" & am em%loye$, & am re#ire$ !o a)i$e )y all %olicies an$ %roce$#res o" !he Walla Walla YMCA.

APPLICANT)S

SIGNATURE_____________________________________________________________________ DATE:________________________

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THE (ALLA (ALLA YMCA IS AN E*UAL OPPORTUNITY EMPLOYER