Permanent Address
Temporary/College
Address
Address:
Address:
Address:
Address:
City:
State:
Zip:
City:
State:
Zip:
Home Phone:
College/Work Phone:
Email Address:
College Email Address:
General Information
Have You Ever Been Employed By A YMCA? Yes
No
If Yes, Give
YMCA Name & Address:
Type Of Employment You Are Seeking:
Full Time
Part Time
Seasonal
Summer
If
You Are Requesting Summer Employment, Which Camp Would You Prefer?
Eljabar (ages 8-14)
Specialty
Position Desired: 1st Choice
2nd Choice
List Job Related Skills:
Current Certifications: (CPR, First
Aid, etc.):
Personal Achievements: (Training, Special Skills, Language Proficiency):
Are You Over 18? Yes
No
If No, Do You Have A Work
Permit? Yes No
Have You Ever Been Convicted Of A Felony? Yes
No
If Yes, Explain:
Hobbies &
Interests:
Organizations/Memberships That You Consider Relevant To Your Ability To
Perform The Job For Which You Are Applying:
Why
Are You Seeking Employment With
Camp Speers-Eljabar YMCA?
Education & Achievements
Education
School
Location
Date From
Date To
Courses/Major
* Degree Type Year
High School
College/Tech School
College/Tech School
Other
Other
*
Insert number of college credit hours completed if no degree obtained.
Employment History List employment
beginning with current or most recent. Account for all periods of time,
list month and year.
Employer/Company:
Supervisor:
City, State:
Telephone:
Position:
Dates
Employed From
To
Brief
Description of Job Duties:
Reason for
Leaving:
Reason for
Lapse of Employment:
Employer/Company:
Supervisor:
City, State:
Telephone:
Position:
Dates
Employed From
To
Brief
Description of Job Duties:
Reason for
Leaving:
Reason for
Lapse of Employment:
Employer/Company:
Supervisor:
City, State:
Telephone:
Position:
Dates
Employed From
To
Brief
Description of Job Duties:
Reason for
Leaving:
Reason for
Lapse of Employment:
Other References (Do not include supervisors listed
above, need 3 names)
Name
Address
Phone
Occupation
By
completing this following section, I hereby declare the information
provided by me in this application for employment is true and complete to
the best of my knowledge. I understand that if employed, any misstatement
or omission of fact on this application shall be considered cause for
dismissal.
Signature of Applicant (Please Type Your Full
Name):
Date:
Social Security Number:
Signature Of Parent If Applicant Is Under 18
Years Of Age (Please Type Full Name Of Parent:
