Online Application for Employment

We 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.

To help us learn about your experience, abilities, and interests, please complete this Application for Employment as thoroughly as possible.
Please complete all sections, even if you are attaching a resume.

PERSONAL INFORMATION

Name:

Email:

Present Address:
City:
State:
Zip:
Number of years at Present Address:

Previous Address:
City:
State:
Zip:
Number of Years at Previous Address:

Home Phone:

Cell Phone:

Can you, after employment, submit verification of your legal right to work in the United States? YES NO

Are you over 18? YES NO

If hired, do you have a reliable means of transportation to get to work? YES NO

Have you ever been convicted of a felony, or for child abuse or sex-related crimes? (Do not include marijuana related convictions which occurred more than two years prior to the date of this application) YES NO

If yes, please explain (A conviction will not necessarily disqualify you):

EMPLOYMENT DESIRED

Type of POSITION desired:

Branch(es) of interest:
Torrington
Winsted
Canaan
Youth Service Bureau
Camp Wa Wa Segowea

Date Available:

Salary Desired:

What is the work schedule you're looking for?

Total hours per week:

Check off days available and list times for those days:

  Day Start End
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Have you ever applied at the Northwest CT YMCA before? YES NO
If yes, when:

Have you ever been employed by the Northwest CT YMCA before? YES NO
If yes, when:

How were you referred to the Northwest CT YMCA?

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Employee Referral - Name of employee:
Walk-In
Agency
Other (please specify) - Please identify source:

EDUCATION AND TRAINING

  School Name and Location From To Graduate? Degree Major
Elementary          
High School     YES NO    
College/Univ. YES NO
College/Univ. YES NO

Highest Degree Earned:

Overall College Scholastic Average:

Additional Education, Vocational and/or Professional Information such as special areas of research or study, seminars, etc. Please attach any written resume or other summary of information that is relevant to the position for which you are applying. If familiarity with a foreign language is listed on the job description, please describe your 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.) Supplement this information by written attachment if applicable.

Typing (words per minute):

Computer Skills (i.e. Excel, Word, etc.):

Other machines requiring special skills:

U.S. MILITARY SERVICE DATA

Branch:

List Special Training or Skills:

EMPLOYMENT DATA

Are you presently employed? YES NO

If yes, may we contact your present employer? YES NO

Please list in order of most recent employment first.

Company Name:

Phone:

Address, City, State, Zip:

Dates of employment - From: To:

Base Rate of Pay - Start: Final:

Supervisor (Name and Title):

Description of Job Duties:

Company Name:

Phone:

Address, City, State, Zip:

Dates of employment - From: To:

Base Rate of Pay - Start: Final:

Supervisor (Name and Title):

Description of Job Duties:

Company Name:

Phone:

Address, City, State, Zip:

Dates of employment - From: To:

Base Rate of Pay - Start: Final:

Supervisor (Name and Title):

Description of Job Duties:

Company Name:

Phone:

Address, City, State, Zip:

Dates of employment - From: To:

Base Rate of Pay - Start: Final:

Supervisor (Name and Title):

Description of Job Duties:

REFERENCES

Name: Company:
Title: Relationship:
Phone:

Name: Company:
Title: Relationship:
Phone:

Name: Company:
Title: Relationship:
Phone:

Reference Authorization:
I, (name), authorize the above listed individuals, including former employers, to release any and all information related to my employment to the Northwest CT YMCA (prospective employer.) I release my former employer, its officers, directors, agents and employees and the Northwest CT YMCA, its officers, directors, agents and employees from all liability arising from the release or obtaining of such information.
Electronic Signature: Date:

PRE-EMPLOYMENT CERTIFICATION

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.

Initials:

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 therefrom.

Initials:

If employed by the YMCA, I will abide by YMCA 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.

Initials:

If I am offered employment, I understand and agree that I may be required to undergo a physical examination at the YMCA’s expense and that my offer of employment may be conditioned by that examination. I agree to authorize release of all results or information obtained from such physical examinations.

Initials:

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.

Initials:

If the YMCA employs me 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 Company 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 the YMCA and myself.

Initials:

SIGNATURE

My signature below certifies that I have read and understand the foregoing and to the best of my knowledge and belief, the information on this form is true and correct.
My 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.

Electronic Signature:
Date:

You may also send a related resume and/or coverletter to: hr@nwcty.org

Please enter both words/numbers that you see below in the box - this helps us prevent "spam" responses to this form - thanks!