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New Regional YMCA
YMCA OF THE CEDAR RAPIDS METRO AREA
Job Application Form
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Job Application Form
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Personal Information
Today's Date
*
Name
*
First
Middle
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
Upload your resume here:
General Employment Information
Position you are applying for:
*
Lifeguard
Swim Lesson Instructor
Welcome Center
Building Supervisor
Wellness Center
Child Watch
Childcare Counselor
Group Wellness Instructor
Sports Official/Referee
Other
Position Applying For (Other):
*
Preferred Location
*
Helen G Nassif YMCA
Marion YMCA
Stoney Point YMCA
Camp Wapsie
The Y at Mercy Health Plaza
Truman Elementary
Van Buren Elementary
Echo Hill Elementary
Work Availability
*
Full-time
Part-time
Seasonal
Which time of day is best for you?
*
Mornings
Afternoons
Evenings
Weekends
Wage/Salary Desired:
*
Please list either the wage per hour or annual salary with just a number, no $ needed. Thank you!
Have you ever worked for YMCA before?
*
Yes
No
If yes, which YMCA?
Relevant Skills, Training or Equipment:
Please list any skills or training, such as computer skills, customer service, official certifications and equipment you can operate.
Check all that apply:
*
I am under the age of 16
I am over the age of 16
I am over the age of 18
If hired, can you provide verification of your legal right to work?
*
Yes
No
How did you learn about this position?
CR YMCA website
Newspaper
Linkedin
Local Job Board Posting
Through a friend
Through a YMCA employee
Through a YMCA member
Other
Referrals:
Please list the names of friends or relatives who work for the YMCA and their relationship to you.
References
Please provide at least 3, non-family references.
First Reference Name
*
First
Last
First Reference Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
First Reference Phone
*
First reference's relationship to you and their occupation:
*
Second Reference Name
*
First
Last
Second Reference Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Second Reference Phone
*
Second reference's relationship to you and their occupation:
*
Third Reference Name
*
First
Last
Third Reference Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Third Reference Phone
*
Third reference's relationship to you and their occupation:
*
Education
High School:
*
High School Address
*
City
State / Province / Region
High School Years Completed:
*
9
10
11
12
Degree Received:
*
College:
College Address
City
State / Province / Region
College Years Completed:
1
2
3
4
Degree Received:
Graduate Work:
Graduate Work Address
City
State / Province / Region
Graduate Work Years Completed:
1
2
3
4
Degree Received:
Other:
Other Address:
Street Address
Address Line 2
City
State / Province / Region
Other Years Completed:
1
2
3
4
Other Degree Received:
Employment History
Please list all positions held starting with the most recent.
If you are currently employed, may we contact your current employer?
*
Yes
No
Employer Name:
*
Employer Address:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Job Title:
*
Start Date:
End Date:
If currently employed, please use today's date.
Wage/Salary:
*
Please list wage per hour or annual salary.
Duties:
*
Supervisor Name:
*
Reason Left:
*
If currently employed, please simply list, "current".
Employer Name:
*
Employer Address:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone:
*
Job Title:
*
Start Date:
End Date:
Wage/Salary:
*
Please list wage per hour or annual salary.
Duties:
*
Supervisor Name:
*
Reason Left:
*
If currently employed, please simply list, "current".
Employer Name:
*
Employer Address:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone:
*
Job Title:
*
Start Date:
End Date:
Wage/Salary:
*
Please list wage per hour or annual salary.
Duties:
*
Supervisor Name:
*
Reason Left:
*
Additional Background Information
Note: Answering "yes" to any of these questions may not necessarily disqualify you from the position you desire. Each action and explanation will be weighted/considered in relationship to the position for which you are applying.
Employment - Discharges & Suspensions:
*
In the past 10 years, have you ever been discharge or suspended form employment for disciplinary reason or have you been asked to resign?
Yes
No
If yes, please explain:
Criminal Background - General:
*
Have you ever been convicted of a crime, had adjudication withheld, or pled no contest to a crime?
Yes
No
Criminal Background - General Explanation:
If yes, please state the type of crime and the circumstances with regard to each including date of conviction, or plea and the penalty, if any imposed by the court.
Criminal Background - Children & Other:
*
Have you ever been convicted or had any administrative finding of violating any law involving child abuse, sexual abuse, physical abuse, child endangerment, sexual harassment or exploitation or crime related to children?
Yes
No
Pending Charges:
*
Do you currently have any charges pending relating to any of the aforementioned?
Yes
No
Pending Charges - Explanation:
If yes, please explain.
Valid Driver's License:
*
If the position for which you are applying requires a valid driver's license, do you have one?
Yes
No
Valid Driver's License - Driving Privileges:
*
Have your driving privileges been suspended or revoked in the past 3 years?
Yes
No
Valid Driver's License - Driving Privileges:
If yes, please explain.
Other Important Information
Why do you wish to work for the Cedar Rapids Metropolitan YMCA?:
*
Please describe your involvement within the community, volunteer groups and other organizations:
Additional Experience:
*
If you feel there is additional information about yourself regarding your skills, experience, accomplishments, etc., that would assist us in evaluating your application, please share the details.
Acknowledgement of Applicant
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 YMCA of the Cedar Rapids Metropolitan Area (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 YMCA the right to terminate my employment at any time without liability or obligation, except for my regular pay through date of termination. I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE ABOVE STATEMENTS AND THAT I VOLUNTARILY SIGN THIS EMPLOYMENT APPLICATION.
I understand and acknowledge the above:
*
Acknowledged
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