YMCA OF GREATER NEW ORLEANS PRE-EMPLOYMENT APPLICATION
YMCA OF GREATER NEW ORLEANS www.ymcaneworleans.org
The YMCA of Greater New Orleans is an equal opportunity employer and will consider all applicants equally without regard to their race, sex, age, color, religion, national origin, veteran status, disability, or any other classification protected by applicable state or federal employment discrimination laws.
Personal Information:
Application Date:____/____/________
Name:______________________________ Social Security #:_________________ First
Middle
Last
Present Address:______________________________________________________ No.
Street
City
State
Zip Code
Mailing Address:______________________________________________________ (if different)
No.
Street
City
State
Zip Code
Phone #:______-_______________ Alternate #:_____-_________________ E-mail Address:_________________________________ Are you eligible to work in the United States?
Yes____ No____
If you are under age 18, can you furnish a work permit? Yes______ No______
Employment Desired: Position(s) Desired:________________________ Date Available:_______________ Full Time______
Part Time______
Seasonal______
Any______
Hours of operation vary by location. Please indicate the days and hours you are available to work:
Days: Mon.____ Tues.____ Wed.____ Thurs.____ Fri.____ Sat.____ Sun.____ Any_____ Hours: Earliest Time:______________ Latest Time:______________ The YMCA of Greater New Orleans operates several branches. The locations of the branches are listed in the box below. Please circle the branches in which you would be willing to accept employment. YMCA Corporate Office 1050 S. Jeff Davis Pkwy, Suite 241 New Orleans Castle Kids Child Development Center 7400 Leake Ave., New Orleans West Bank YMCA at Federal City 2220 Constitution, New Orleans
East Jefferson YMCA 6691 Riverside Dr., Metairie West St. Tammany YMCA 71256 Francis Rd., Covington Belle Chasse YMCA 8101 Hwy 23, Belle Chasse
YMCA Learning Center New Orleans Public Library 219 Loyola Ave., New Orleans Plaquemines Parish Community Centers YMCA Port Sulphur, Davant, Boothville, Buras
Education and Training: Name and Location
Dates
Graduate? Major/Courses Studied
High School Yes No College (undergraduate)
From: Yes
Degree (if no degree, indicate # of hours & study area):
To: No College (graduate)
From: Yes
Degree (if no degree, indicate # of hours & study area):
To: No Business/Trade/Other
From: Yes
Degree (if no degree, indicate # of hours & study area):
To: No
•Have you ever applied to the YMCA of Greater New Orleans before? Yes______ No______ If yes, when did you apply?_____________________ •Have you ever worked for the YMCA of Greater New Orleans or any other YMCA? Yes______ No______ If yes, please give dates and branch location:____________________ ______________________________________________________________________________ •Have you been convicted of or pleaded no contest to a felony or misdemeanor? Yes______ No______ If yes, please give date, offense, and outcome:__________________ _____________________________________________________________________________ (Previous convictions do not necessarily disqualify an applicant from employment)
•Do you have any relatives who work for the YMCA?
Yes______ No______
If yes, please give names and branches:___________________________________________
Computer Skills: Are you proficient with Microsoft Office? Word____ Excel____ Outlook____ Powerpoint____ Please list any other computer experience you have:__________________________________ _______________________________________________________________________________ How would you rate your ability to learn new computer skills? Good____ Fair____ Poor____
Employment History: List names of employers in consecutive order, starting with your present or most recent employer. If self-employed, give business name and supply references. Do not reference your resume. Name of Employer
Date of Employment From _______ mo.______ yr. To______ mo. ______yr.
Address of Employer
Phone # __________ - __________ - ______________
Job Title
Salary Beginning_______________ Ending________________
Supervisor’s Name
Reason for Leaving
Duties
Name of Employer
Date of Employment From _______ mo.______ yr. To______ mo. ______yr.
Address of Employer
Phone # __________ - __________ - ______________
Job Title
Salary Beginning_______________ Ending________________
Supervisor’s Name
Reason for Leaving
Duties
Name of Employer
Date of Employment From _______ mo.______ yr. To______ mo. ______yr.
Address of Employer
Phone # __________ - __________ - ______________
Job Title
Salary Beginning_______________ Ending________________
Supervisor’s Name
Reason for Leaving
Duties
Personal References: Please list two non-related personal references who have known you for at least one year. Name: Address: Phone #: 1.______________________________ _______________________________ ______________ 2.______________________________ _______________________________ ______________
Professional References: Please list two non-related professional references who are familiar with your work habits. Name: Address: Phone #: 1.______________________________ _______________________________ ______________ 2.______________________________ _______________________________ ______________
Family Reference: Please provide a close relative who would be willing to provide a character reference for you. Name: Address: Phone #: 1.______________________________ _______________________________ ______________
Additional Information: Please provide any additional information you want us to consider in evaluating your application for employment. This may include volunteer experience, foreign language skills, YMCA affiliation, awards, or other relevant information.
________________________________________________________________________________ ________________________________________________________________________________ Certification and Signature: I certify that all information contained in this application is true and complete to the best of my knowledge. It is understood that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed. Furthermore, I understand that I am free to resign at any time. The employer reserves the right to terminate my employment at any time, with or without cause and without prior assurances to the contrary. I give the employer the right to investigate and contact all references and employers and to secure additional information about me, if job related. I hereby release from liability the employer and its representative for seeking such information and all other persons, organizations, or corporations, for furnishing such information. The YMCA of Greater New Orleans is an equal opportunity employer and does not discriminate in its employment practices. No question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law. This application is active for three months from the date of application. If I still want to be considered for employment at the conclusion of this time, it will be necessary to fill out a new application.
Signature of Applicant:________________________________________ Date:____________________________ Deliver or mail completed application form to nearest YMCA Branch or the Human Resources Department. The Human Resources Department is located at the corporate office: YMCA of Greater New Orleans; 1050 South Jefferson Davis Parkway, Suite 241; New Orleans, LA 70125; TEL 504-568-9622; FAX 504-821-7089. For HR Use Only: Entered:_____________ Interviewed:_______ Referred:__________________________________