YMCA Blue Ridge Assembly


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Application for Summer Employment

YMCA Blue Ridge Assembly
84 Blue Ridge Circle
Black Mountain, NC 28711
PHONE (828) 669-8422
FAX (828) 669-8497
Owned by the YMCAs of the South

	Employment Overview
		About
		Location
		Application Process
		Employment Dates
		Policies and Expectations
	Employee Life and Programs
		Departments
		Staff Benefits
		Internships
		Values
	Positions and Job Descriptions
		Conference Support Staff
		Supervisory Staff
	International Applicants
	Application Form
	Reference Form
	Contact Us

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or handicap. We are an equal opportunity employer. Your response to any question will not be used as a basis for discrimination but will be judged on its relevance to the position you are seeking.

International Applicants, please read this before completing application.

NOTE: If this form is submitted before you are finished, use your browser’s Backbutton to return to where you left off. (Pressing the Enterkey may submit the form prematurely.)

General Information


Personal Information	Last Name
First Name
Middle Name
Social Security Number		optional


Current Address	Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Current Phone
Email
Date through which current address and phone number are valid


Permanent Address	Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Permanent Phone

Citizenship

Country of citizenship

If not a US citizen, can you obtain a work visa for employment?

YesNo

If not a US citizen, how well do you speak the English language?

I understand that if offered a job I will be permitted to work only after providing YMCA Blue Ridge Assembly with documentation establishing my identity and my legal authorization for employment in the United States. I am legally authorized for employment as a citizen or national of the U.S., a lawful Permanent Resident Alien, or an alien otherwise permitted to work in the United States.

YesNo


Are you 18 years old or older?	YesNo
Do you have a driver’s license?	YesNo
If yes, give state and license number	#
Country, if not U.S.
Have you ever been convicted of violating any laws (not including minor traffic violations)?	YesNo
If yes, give details: (A ‘yes’ answer does not automatically disqualify your from employment. The date and nature of the offense and the jobs for which you are applying will all be considered.)


What is the earliest date you will be available?
What is the latest date through which you can remain?
In the event you are not offered a job, do you wish to have your application placed on file for possible consideration later in the season?	YesNo

Have you ever applied for employment at YMCA Blue Ridge Assembly before? If yes, when?
Have you ever been employed by YMCA Blue Ridge Assembly? If yes, when?

Education


High School	Name
City
State/Province
Country
Attended from: to:
Field of Study
Completed Degree


College or Technical School	Name
City
State/Province
Country
Attended from: to:
Field of Study
Completed Degree


Graduate/Professional	Name
City
State/Province
Country
Attended from: to:
Field of Study
Completed Degree


Other School	Name
City
State/Province
Country
Attended from: to:
Field of Study
Completed Degree

Describe Course of Study
Describe Specialized Training
Apprenticeship, Skills, etc.
Honors Received

Work Experience

List employment beginning with current or most recent.Account for all periods of time including self-employment and military service. List the month and year for each employment period. Employer telephone numbers are required.

Most Recent Employer
Start Date
End Date
Employer/Company
Supervisor
City
State/Province
Country
Phone
Hourly Rate and/ or Salary
Brief Description of Job Duties
Reason for Leaving

Second Employer
Start Date
End Date
Employer/Company
Supervisor
City
State/Province
Country
Phone
Hourly Rate and/ or Salary
Brief Description of Job Duties
Reason for Leaving

Third Employer
Start Date
End Date
Employer/Company
Supervisor
City
State/Province
Country
Phone
Hourly Rate and/ or Salary
Brief Description of Job Duties
Reason for Leaving

Fourth Employer
Start Date
End Date
Employer/Company
Supervisor
City
State/Province
Country
Phone
Hourly Rate and/ or Salary
Brief Description of Job Duties
Reason for Leaving

YMCA Employment
Have you ever worked for any YMCA before?	Yes No
If yes, which one(s)?
1.
Start Date
End Date
Salary/or Hourly rate:

2.
Start Date
End Date
Salary/or Hourly rate:

3.
Start Date
End Date
Salary/or Hourly rate:

Qualifications

Certifications

Please list any current certifications along with expiration dates, such as Lifeguard, CPR, EMT, First Aid, etc. Actual current certifications must be provided at the time of arrival at YMCA Blue Ridge Assembly.

1.
Expires

2.
Expires

3.
Expires

4.
Expires

5.
Expires


What specifically attracts you to YMCA Blue Ridge Assembly?


Summarize any special skills and qualifications acquired from employment or other experience:


We encourage you to list any additional information about yourself which you feel is pertinent. You may choose to include information such as ability to speak foreign languages, special skills, awards, involvement with service organizations, program development, hobbies, etc. Do not include labor organizations or memberships which reveal race, color, national origin, sex, age, disability or other protected status.


Volunteer Work: List church, school, professional, business and civic organizations in which you have been actively involved.

Have you read and do you understand the essential functions described in the online job descriptions?	Yes No

Please indicate the position(s) for which you are applying at Blue Ridge Assembly:	House Keeping Dining Room Cook Guest Services Support Staff Aquatics Maintenance Security Guard Crafts Child Care Adventure Programs Conference Services

I am available for employment as follows:	Permanent Part-Time Summer Only
List times available

Personal References

Please provide three references not related to you. List names, addresses, and phone numbers below and print 3 copies of the online reference form for your references to complete.

Name

Address

City

State/Province

Zip/Postal Code

Country

Phone

Relationship

Name
Address
City
State/Province
Zip/Postal Code
Country
Phone
Relationship

Name
Address
City
State/Province
Zip/Postal Code
Country
Phone
Relationship

Referring Source

How did you learn about employment opportunities at YMCA Blue Ridge Assembly? Please check all that apply.

School Placement Office

An Employment Directory

Another YMCA

Friend or Relative

I attended a conference at
YMCA Blue Ridge Assembly.

I have visited YMCA Blue Ridge Assembly’s facilities with my family.

Other Source

YMCA Blue Ridge Assembly is an equal opportunity employer and your response to any question will not be used as a basis for discrimination but will be judged on its relevance to the positions you are seeking.

Agreement

I certify that the information contained in this application is true and accurate to the best of my knowledge. I understand that falsification of this application in any detail is grounds for disqualification from further consideration or for dismissal. I hereby authorize YMCA Blue Ridge Assembly to contact my previous employers and my personal references, and I understand that the Assembly may choose to do a background investigation which may involve contacting some or all of the following sources: Criminal Court Clerk, Department of Human Services and any relevant state bureau. I hereby authorize all of these sources to release information about me, and I understand that YMCA Blue Ridge Assembly may contact other sources not listed herein.
I agree to conform to the rules and policies of YMCA Blue Ridge Assembly and understand that my employment and compensation can be terminated, with or without cause, at any time, at the option of either the Assembly or myself. I understand that no representative of YMCA Blue Ridge Assembly has any authority to enter into any agreement for any specified period of time unless the agreement is in writing and signed by the Executive Director, Operations Director or Staff Development Director.

Type your full name here to signify your agreement.

If you are under 18, a parent or guardian must certify the following statement:

I agree to have my child work at Blue Ridge Assembly under the prescribed conditions.

Type your full name here to signify your agreement.

Please press the submit button only once and wait to receive confirmation of submission.

YMCA Blue Ridge Assembly
84 Blue Ridge Circle
Black Mountain, North Carolina 28711
www.blueridgeassembly.org
828.669.8422