EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION

Fond du Lac Family YMCA, 90 W. 2nd Street, Fond du Lac, WI
We are an Equal Opportunity Employer. The YMCA Welcomes a Diverse Workforce.
POSITION APPLYING FOR

Please check all departments you would like to be considered for.
Type a question*

AquaticsBuilding SupervisorChild CareChild WatchGroup ExerciseMaintenanceMembership/Member ServicesPersonal TrainingPreschool EnrichmentSportsWellnessOther
Please list specific position(s) applying for:*
Please submit your resume, if applicable.

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APPLICANT INFORMATION
Applicant Name*

First NameLast Name
Applicant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Email Address*
example@example.com
Applicant Daytime Phone*
Please enter a valid phone number.
Applicant Evening Phone*
Please enter a valid phone number.
Are you at least 18 years old?*

YESNO
Date of birth (if under 18):

MonthDayYear
Date
Have you ever been convicted or have charges pending of a crime (felony or misdemeanor)?*

YESNO
If yes, please explain 1) Nature of the crime; 2) Date of conviction; 3) State in which convicted. Convictions are not an automatic bar to employment. However, failure to provide complete and accurate information relating to criminal convictions will result in immediate termination. We conduct criminal record checks on all employees. Employment is contingent upon the results of the criminal record check.If you are unsure how to complete this information, please contact the Human Resources Department.
Please list your addresses in the past 5 years:*
AVAILABILITY: Please indicate all that apply:*

Part-timeFull-timeYear-roundSummerSchool year
When can you start?*

MonthDayYear
Date
Are you interested in volunteer work?*

YesNo
Have you been paid to work for a YMCA organization in the past?*

YesNo
If yes, which YMCA and when did you work for that organization?
How did you learn about this employment opportunity?*

Community AgencyEmployee ReferralEmployment AgencyGovernment AgencyJob FairNewspaperSchool/CollegeSocial MediaWalk-inWisconsin Job CenterYMCA WebsiteOther
If an employee referral, please list first and last name of Fond du Lac Family YMCA employee:
EDUCATIONAL BACKGROUND
HIGH SCHOOL INFORMATION - Please list name & address of your High School
COLLEGE/UNIVERSITY INFORMATION - Please list name & address of your College/University
POST GRADUATE SCHOOL INFORMATION - Please list name & address of your Post Graduate School
BUSINESS/TECHNICAL SCHOOL INFORMATION - Please list name & address of your Business/Tech School
WORK HISTORY - List current & past employers

Paid and unpaid labor
Are you currently employed?*

YesNo
If yes, list your work schedule:
May we contact your current employer for reference purposes?*

Yes (List current employer(s) below)No
May we contact your past employer(s) for reference purposes?*

Yes (List past employer(s) below)No
EMPLOYER - Current or Past
EMPLOYER - Current or Past
EMPLOYER - Current or Past
EMPLOYER - Current or Past
REFERENCES

List individuals familiar with your job qualifications. Please include one family member/relative.
REFERENCE 1*
REFERENCE 2*
REFERENCE 3*
Please list any certifications, date received, and expiration date:
Please describe any software knowledge or office equipment exerience:
Please describe what makes you feel qualified to fill the desired position:*
Please list general days (Mon-Sun) and times (Morning/Afternoon/Evening) of your availability to work *
Fond du Lac Family YMCA Code of Ethics

Below are statements of our Code of Ethics we expect all staff to demonstrate and follow. Please read the statements carefully before signing.
• Our staff will exhibit the highest ethical best practices and personal integrity.
• Our staff will provide a professional work environment that is free from physical,
psychological, written, or verbal intimidation or harassment.
• Our staff will not physically, sexually, or emotionally abuse or neglect a youth or
adult.
• Our staff will share concerns about suspicious or inappropriate behavior with their supervisor or administrator.
• Our staff will report any suspected abuse or neglect of a youth to the state
authorities.
• Our staff will accept their personal responsibility to protect youth and adults from all forms of abuse.
My signature indicates that I have read and understand the above statements.
Signature*

Clear
Please read carefully before signing this application.

Our organization appreciates your willingness to share your skills. Providing safe and secure programs for our members is of utmost importance to us. The information gathered in this application is designed to help us provide the highest quality programs for the people of our community. Please read the statements below carefully before signing.

1. All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired.

2. I understand that I can withdraw from the application process at any time.

3. I authorize the Fond du Lac Family YMCA to investigate and verify any and all information provided on this employment application. Such information and verification whether favorable or unfavorable may be provided by present or former employers or any individual familiar with my employment background or me. I voluntarily and knowingly fully release and hold harmless any person
or organization that provides information pertaining to my employment or me.

4. Regardless of whether or not I become employed by the Fond du Lac Family YMCA, I recognize that this application is not and should not be considered a contract of employment. I understand that employment at the Fond du Lac Family YMCA is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or the Fond du Lac
Family YMCA’s unless specifically provided otherwise. I further understand that no Fond du Lac Family YMCA employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other than an officer or official of the Fond du Lac Family YMCA and then only by means of a signed written document.

5. This application for employment shall be considered active for a period not to exceed 90 days.

My signature indicates that I have read and understand the above statements.
Signature*

Clear
IMMIGRATION AND NATURALIZATION SERVICE INFORMATION
The Fond du Lac Family YMCA hires only United States citizens and aliens lawfully authorized to work in the United States.

In the event you are offered and accept a position with the Fond du Lac Family YMCA, you will, as a condition of employment, be required to complete and sign an Employment Eligibility Verification Form I-9. You will also be required to present original documentation, which both identifies you and establishes your work authorization within three days of your date of hire. If, after you have been hired, any documentation has expired, it is your responsibility to provide your supervisor with current documentation immediately. Failure to do so will result in immediate termination with the Fond du Lac Family YMCA without prejudice to future employment application. This applies to U.S. citizens as well as aliens.

For many persons, the presentation of a social security card, along with either a picture driver’s license or state identification card, will be sufficient documentation of identity and work authorization. However, certain other documents will also be acceptable. If you wish to know a complete list of acceptable documents, please speak to the person who is responsible for the hiring of the position for which you are applying. This list can also be obtained from the nearest office of the United States Citizenship and Immigration Services.

If there are any special circumstances that make you exempt from any part of the verification procedures, please inform the Fond du Lac Family YMCA’s representatives at the time the verification is requested. Nothing contained therein should be construed by you to be an offer of employment or a promise of any nature.
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EMPLOYMENT APPLICATION

POSITION APPLYING FOR

APPLICANT INFORMATION

EDUCATIONAL BACKGROUND

WORK HISTORY - List current & past employers

REFERENCES

IMMIGRATION AND NATURALIZATION SERVICE INFORMATION