Apply Online

Personal Information

Position Applying For

Name

Email

Phone

Address

City/Town

State/Province

ZIP/Postal Code

Questions	Yes	No
Are you 18 years of age or older? If not, you will be required to provide work authorization.	Yes	No
If hired, can you provide verification of your legal right to work in the United States?	Yes	No
Do you certify that you are suitable for a position of trust with our members/program participants?	Yes	No
Can you perform the essential functions of the job for which you are applying, with or without reasonable accommodations?	Yes	No
Have you ever been convicted of a felony, child abuse or sex-related crimes? If yes, please provide date, location, charges and a complete explanation of all offenses. A felony conviction will not necessarily bar employment.	Yes	No

Military Service Data

Are you currently serving or have you ever served in the U.S. Military? If yes, please list branch and years of service.

Yes

No

Military Branch and Years of Service

Employment Information

List Available Days/Hours

Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
Hours	Hours	Hours	Hours	Hours	Hours	Hours

Preferred Job Status

Full-Time

Part-Time

Seasonal

As Needed

Have you previously been employed by this YMCA or any other YMCA?

Yes

No

If yes, when? At which locations?

Have you previously volunteered at this YMCA or any other YMCA?

Yes

No

If yes, when? At which locations?

Do you have any relatives or household members currently working for this YMCA?

Yes

No

If yes, name(s) and relationship:

How did you hear about this opening?

YMCA Staff Referral

School

Walk-In

YMCA Website

Agency

Other…

Education & Training

Highest Level of Education Achieved

High School/GED

College

Vocational/Other

Please provide name of school and if diploma was received.

Please provide name and location of school, degree/major and if diploma was received.

Please provide name and location of school and trade.

Describe any non-employment experience such as school or volunteer activities that might strengthen your application:

Please provide safety and job specific certifications (CPR, First Aid, etc.).

Employment History

Current/Previous Employers

Re-order	Employer	Job Title	Immediate Supervisor and Job Title	Reason for Leaving	Dates Employed	Hourly Rate/Salary	Job Responsibilities	May we contact this employer?	Telephone	Weight	Operations
	Employer	Job Title	Immediate Supervisor and Job Title	Reason for Leaving	Dates Employed	Hourly Rate/Salary	Job Responsibilities	May we contact this employer? Yes No	Telephone	Item weight

Please explain any gaps in your employment history.

What other business experience, personal experience or training have you had that may have prepared you for this position (i.e. computer skills, training, supervision experience, etc.)?

Volunteer History

Current/Previous Volunteer Opportunities

Re-order	Company/Organization	Telephone	Dates Volunteered	Address	Supervisor	May We Contact	Role/Responsibilities	Weight	Operations
	Company/Organization	Telephone	Dates Volunteered	Address	Supervisor	May We Contact Yes No	Role/Responsibilities	Item weight

Personal/Professional References

Name

Relationship to Applicant

Years Known

Occupation

Primary Phone

Email

Alternate Phone

Name

Relationship to Applicant

Years Known

Occupation

Primary Phone

Email

Alternate Phone

Name

Relationship to Applicant

Years Known

Occupation

Primary Phone

Email

Alternate Phone

Application Acknowledgment and Authorization

Please read all statements and sign below:

I authorize both the YMCA and persons listed [references, schools, current (unless noted) and former employers and any others with whom you desire to check] to communicate with regard to any relevant information that may be required to reach an employment decision. I agree to hold such persons harmless with respect to any information they may supply. I understand and agree that any offer of employment is contingent upon successful completion of all background checks.

I certify that all information provided by me in this application is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation, or omission of any facts in this application or any other document submitted in connection with YMCA employment will result in denial of employment or termination of employment regardless of the timing or circumstances of discovery.

If I am employed by the YMCA I understand my employment can be terminated, with or without cause and with or without notice, at any time at the option of the YMCA or myself. I understand that, other than the CEO of the YMCA, no manager, supervisor or representative of the YMCA has authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. Only the CEO of the YMCA has the authority to make any agreement contrary to the foregoing and then only in writing. I further expressly agree that, with respect to the at-will employment relationship, this constitutes the full, complete and final expression of the parties’ intent concerning the nature of any employment relationship between myself and the YMCA.

If I am offered employment, I understand and agree that I may be required to undergo a physical examination and that my offer of employment will be conditional upon that examination. I agree to authorize release of all results or information obtained from such physical examinations. I agree to submit to legally permissible drug and/or alcohol testing upon request by the YMCA. I recognize that the results of these tests may be used to determine my employment or continued employment. I understand and expressly agree that if employed by the YMCA storage areas provided for me (locker, file cabinet, computer files, desk, etc.) are open to investigation by the YMCA without prior notice to me.

I understand that all offers of employment are conditional upon my ability to provide appropriate documents regarding my identity and legal right to work in the United States. I understand that this application is only valid for the position applied for at present and that the YMCA is not obligated to retain or consider this application for future openings. I understand that I will be required to possess a current and valid driver’s license if my position requires me to drive in the course of my work. If hired, I agree to abide by YMCA policies and rules at all times. I acknowledge that I have read the above statements and understand them.

Signature

Sign above

Employment Application

Please complete the employment application below and submit to the Chambersburg YMCA through the form below

Personal Information

Military Service Data

Employment Information

Education & Training

Employment History

Volunteer History

Personal/Professional References

Application Acknowledgment and Authorization