| Name |
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| Social Security Number |
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| Address |
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| City |
State
Zip
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| Current Phone |
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| E-Mail |
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| Drivers License State |
License Number
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| Citizen of what country |
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| Are You At Least 18 Years Old |
Yes
No
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| Earliest Date Available |
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| Latest Date Available |
|
| Worked at Blue Ridge Before? |
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| If yes, when? |
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| Ever convicted of a crime? |
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| If yes, give details |
|
| (A 'yes' answer does not automatically disqualify you from employment) |
| The date and nature of the offense and the jobs for which you are applying will be considered. |
| |
| List church, school, business, and civic groups in which you have been involved. |
|
| |
| List pertinent personal information: additional skills, languages, hobbies, awards. Do NOT include organizations or memberships which might reveal race, national origin, disabilities, or other protected information. |
|
|
| |
| What specifically attracts you to Blue Ridge Assembly? |
|
| |
| Please indicate the position(s) which interest you at Blue Ridge |
| Housekeeping
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 OnlyTimes Available |
| |
| References: Give name, address, phone number of three references. One should be a family member. |
| 1 |
| 2 |
| 3 |
| |
| |
| |
| By clicking to submit this form, you certify that the information contained in this application is tru and accurate to the best of your knowledge. You also agree that falsification of this application in any detail is grounds for disqualification from further consideration of or dismissal from employment. You also agree to authorize YMCA Blue Ridge Assembly to contact your references. |
| You also agree to the rules and policies of YMCA Blue Ridge Assembly and understand that your employment can be terminated, with or without cause, at any time, at the option of the assembly or yourself. You also understand that no representative of YMCA Blue Ridge Assembly has any authority to enter into any agreement for a specified period of time, unless the agreement is in writing and signed by the executive director, operations director, or staff development director. |
