application for  employment

 

We consider all applications for all positions without regard to race, color, religion, sex, national origin, age, marital
or veteran status, the presence of non-job-related medical condition or handicap, or any other legally protected
status.

 

Position(s) applied for: ________________________________________________________  Date: ______________

How did you learn about us?       £ Advertisement            £ Friend           £ Walk-in         £ Employment Agency

                                                £ Relative                     £ Other: _______________________________________  

 

GENERAL INFORMATION

Last Name:_______________________________ First Name: ______________________________  M.I. _________

Street Address: __________________________________________________________________________________  

City: ____________________________________  State: _____________________ Zip: _______________________

Phone: (home) ____________________________  (cell) ______________________ (other) _____________________

Social Security Number_____________________

 

If you are under 18 years of age, can you provide proof of your eligibility to work?    £ Yes    £ No

Have you aver filed an application with us before?   £ Yes    £ No

Have you ever been employed with us before?   £ Yes   £ No

Are you currently employed?   £ Yes    £ No

If so, can we contact your present employer?   £ Yes    £ No

Are you looking for P/T or F/T work?   If P/T, how many hours per week are you willing to work?_________________

Are you prevented from becoming employed in this country because of Visa or Immigration Status?  £ Yes    £ No

Proof of citizenship or immigration status will be required upon employment.

Are you currently on “lay off” status and subject to recall?   £ Yes    £ No

Can you travel if a job required it?   £ Yes    £ No

Do you have a valid PA driver’s license?   £ Yes    £ No

Have you been convicted of a felony within the last 7 years?   £ Yes    £ No

If Yes, please explain:_____________________________________________________________________________

 

EDUCATION

Highest grade completed: _________________________________  High School: _____________________________

College: _______________________________________________  Degree: _________________________________

Other Training/Credentials/Honors: __________________________________________________________________

_______________________________________________________________________________________________

 

CURRENT CERTIFICATIONS

£  First Aid       Exp. Date: ___________	£  Red Cross Lifeguarding          Exp. Date: ___________
£  CPR            Exp. Date: ___________	£  Water Safety Instructor          Exp. Date: ___________
£  Other: ________________________________________________________________________________

 

EMPLOYMENT EXPERIENCE

Employer: ______________________________________  Dates Employed: _______________  to ______________

Address: _______________________________________  Phone Number: _________________________________

Job Title: _______________________________________  Supervisor: _____________________________________

Work performed: _________________________________________________________________________________

Reason for leaving: _______________________________  Starting Salary: _________ Ending Salary: ___________

 

Employer: ______________________________________  Dates Employed: _______________  to ______________

Address: _______________________________________  Phone Number: _________________________________

Job Title: _______________________________________  Supervisor: _____________________________________

Work performed: _________________________________________________________________________________

Reason for leaving: _______________________________  Starting Salary: _________ Ending Salary: ___________

 

Employer: ______________________________________  Dates Employed: _______________  to ______________

Address: _______________________________________  Phone Number: _________________________________

Job Title: _______________________________________  Supervisor: _____________________________________

Work performed: _________________________________________________________________________________

Reason for leaving: _______________________________  Starting Salary: _________ Ending Salary: ___________

 

 

REFERENCES

Give name, address and telephone number of three references who are not related to you and are not previous
employers.

1.                                                                                                                                                                                                                                                                                                                                            

2.                                                                                                                                                                                                                                                                                                                                            

3.                                                                                                                                                                                                                                                                                                                                            

 

 

 

The YWCA Gettysburg and Adams County is an equal opportunity employer and selects the best matched
individual for the job based upon job related qualification, regardless of race, creed, sex, national origin,
age, handicap or other protected groups under state, federal or local Equal Opportunity Laws.

 

I understand and agree that:

1.  Any material misrepresentation or deliberate omission of a fact in my application may be justification for refusal of, or if employed, termination
from employment.

2.  It is my understanding that the YWCA will make a thorough investigation of my entire work history and may verify all data given in my
application for employment, related papers, or interviews.  I authorize such investigation and the giving and receiving of any information
requested by the YWCA and I release from liability any person giving or receiving any such information.  I understand that falsification of data
so given or derogatory information discovered as a result of this investigation may prevent my being hired, or if hired, may subject me to
immediate dismissal.

3.  I agree that my employment may be terminated by the organization at any time without liability for wages or salary except such may have
been earned at the date of such termination.  If requested by the management at any time, I agree to submit to search of my person or of any
locker that may be assigned to me, and I hereby waive all claims for damages on account of such examination.  I authorize any physician or
hospital to release any information which may be necessary to determine my ability to perform the duties of a job I am being consider for prior
to employment or in the future during employment with the YWCA.

4.  Although management makes every effort to accommodate individual preferences, business needs may at times make the following
conditions mandatory; overtime, shift work, a rotating work schedule, a work schedule other than Monday through Friday.  I understand and
accept these as conditions for my continuing employment.

 

I further understand that this is an application for employment and that no employment contract and that no employment contract is being
offered.  I understand that if I am employed, such employment is for no definite period of time and that YWCA can change wages, benefits and
conditions at any time.  I have read and understand the above. 

 

 

____________________________________________________________________________       _________________________________

Signature of Applicant                                                                                                                            Date