Employment/Volunteer Application Employment/Volunteer Application Application for Employment/VolunteerWe are an Equal Opportunity Employer. Applicants for all job openings are welcome and will be considered without regard to race, color, religion, national origin, sex, age, sexual orientation, physical or mental disability, or any other basis protected by state, federal or local law. It is the intent of the YMCA to comply with all applicable federal, state and local legislation concerning equal opportunity in employment. For which are you applying?* Employment Volunteer Personal InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone NumberEmail*This will be our primary means of communicating with you. Are you over 16 years of age?* Yes No Can you, after employment, submit verification of your legal right to work in the United States?* Yes No Employment/Volunteer Position DesiredType of POSITION desired:*Please select one or more options. Select All Before/After School Program Fitness Instructor Maintenance Swim Instructor Certified Lifeguard Competitive Swim Coach Personal Trainer Youth Sports Child Watch/ Youth Drop-In Front Desk Preschool Wellness Center Staff Other Date Available* MM slash DD slash YYYY What type of position are you looking for?* Full-Time Part-Time Seasonal Are you presently employed?* Yes No If Yes, may we contact your present employer?* Yes No Have you ever applied at the Kishwaukee Family YMCA before?* Yes No If Yes, when?Have you ever been employed at the Kishwaukee Family YMCA before?* Yes No If Yes, when?How were you referred to the Kishwaukee Family YMCA?* Advertisement Employee Referral Walk-In Agency Other Please note your days/hours of availability*MondayTuesdayWednesdayThursdayFridaySaturdaySunday Education and TrainingHigh SchoolHigh School NameLocation Graduate Yes No GED College/UniversitySchool NameLocation Years AttendedStart (Year)End (Year) Graduate Yes No DegreeMajorAre you currently in School?* Yes No If Yes, Please list school Name BelowAdditional Education, Vocational and/or Professional Information. Please list any foreign language skills below.Professional memberships, certificates or licenses held. (Exclude those indicating race, color, religion, sex, sexual orientation, national origin, age, physical or mental disability or labor organization affiliations.) Please provide a copy.File Drop files here or Select files Max. file size: 2 MB. Computer Skills, i.e. Microsoft Office- Word, Excel, Outlook, etc.Please list any awards or recognition.Reference DataPlease list a Professional Reference:NameProfessionPhone Number Please list a Professional Reference:NameProfessionPhone Number Please List an Immediate Family Member ReferenceNameRelationshipPhone Number Employment /Volunteer HistoryPlease list the most relevant employment first.Company Name Company Name Company Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneDescription of Job DutiesPlease include Job Titles Start and Finish.Dates of EmploymentStart (Month/Year)End (Month/Year) SupervisorNameTitle Company Name Company Name Company Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneDescription of Job DutiesPlease include Job Titles Start and Finish.Dates of EmploymentStart (Month/Year)End (Month/Year) SupervisorNameTitle Resume and Cover LetterPlease upload your resume and cover letter if required for the position. Drop files here or Select files Max. file size: 2 MB. Pre-Employment CertificationStatement 1*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. Initial Statement 2*I understand that as a VOLUNTEER, I am not covered under the Kishwaukee Family YMCA Workman's Comp Insurance for any injuries I sustain during the time I volunteer at the YMCA. I understand that I am responsible for my own insurance coverageInitial Statement 3*I authorize investigation of all statements contained in this application. I understand that falsification, misrepresentation or omission of facts called for will result in immediate termination from employment or removal of my application from consideration. I authorize the YMCA to secure information about my experience with former employers, education institutions and agencies, and for those parties to provide information concerning my experience releasing all parties from any liability arising therefromInitial Statement 4*If employed by the YMCA I will abide by Association policies and rules. 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.Initial Statement 5*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, desk, etc) are open to investigation by the YMCA without prior notice to me. Initial Statement 6*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 tinme 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 the 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. Initial Statement 7*My signature below certifies that I have read and understand the foregoing and to the best of my knowledge and belief, the infromation on this form is true and correct. My electronic signature below also certifies that I agree to be bound by the terms and conditions stated in this application. This application contains all the understandings and agreements between me and the YMCA concerning the nature of my employment, if any, by the YMCA and supersedes all prior and/or contemporaneous practices, oral or written agreements, understandings, statements, representations and promises, express or implied, between me and the YMCA. I understand and agree that, except as noted above, no person who is either an agent or employee of the YMCA may modify, delete, vary or contradict, whether orally or in writing, the terms and conditions set forth herein.SignatureDate of Application