Cleveland County YMCA

Employment Application

We would love you to join our cause with a career at Cleveland County Family YMCA!

Please fill out the employment form below, and we'll review it as soon as possible.

Personal Data

Current Address

Previous Address

Dates living at this address

Other Cities, Counties, and States You've Lived/Worked

If you are hired, you will be required to furnish proof of your employment eligibility.
Maiden name, other surnames, etc.


A conviction does not automatically mean you will not be offered a job. What you were convicted of, the circumstances surrounding the conviction, and how long ago the conviction occurred are important considerations in determining your eligibility. Give all the facts so that a fair decision can be made.


List all positions you have held, beginning with your most recent. Include self-employment and volunteer work.

Current or Previous Employer

Next Previous Employer

Next Previous Employer


High School



Trade School


Special Skills

List all current special license(s), permit(s), certification(s), and level or credited hours (CPR, lifeguard, First Aid, etc.).

Personal References

List four references. Must include one relative. At least one reference must be a male and one reference a female. References must not be a current or former employers.





Please Read Carefully Before Submitting

I hereby certify that the information provided on this application is accurate to the best of my knowledge and subject to verification by the YMCA. I authorize the schools, persons, previous employers, agencies, and other organizations named in this application to provide YMCA (its authorized employees, agents, or representatives) with any relevant information that may be required to arrive at an employment decision and hereby release any such schools, persons, employers, agencies, and organizations from any and all liability which they might otherwise incur as a result. I understand that any misrepresentation or omission of a material fact on my application may be justification for refusal of employment.

In the event that I am employed, I understand that all employees are subject to termination at the discretion of the YMCA. If, in the event I choose to voluntarily terminate my employment, I am free to do so at any time, and, if I choose to give proper notice of termination, the association may either permit me to continue my employment during the notice period or may accept my resignation immediately.

I understand that, in the event I am employed by the YMCA, my compensation, hours of employment, and all other terms and conditions of employment are subject to modification or change by the YMCA at the YMCA's discretion.

I also understand that, if employed, any misrepresentation made by me completing this application shall be considered as sufficient cause for my dismissal without advance notice.

I authorize the YMCA to supply my employment record, in whole or in part, and in confidence, to any prospective employer, government agency, or other party, with legal and proper interest.

In the event of my employment, I will comply with all rules and regulations as set forth in the YMCA's policy manual or other communications distributed to employees, and understand a condition of my continued employment will be my compliance with the YMCA's controlled substance abuse and testing policy. I understand and support the YMCA's position on the problem of child abuse.

I understand that beginning and continuing employment at the YMCA depends, in part, on the following:

  1. Passing a drug screen and/or physical examination, if requested by the YMCA, to be given by a doctor, nurse, or medical facility selected by the YMCA.
  2. Satisfying the YMCA's requirements concerning:
    1. Step One Survey,
    2. My driving record,
    3. My criminal history record,
    4. Reference checks, and
    5. documents required by law.

I understand that as long as my employment with the YMCA lasts, the YMCA may repeat any or all of the above requirements at any time.

I understand that completion of this form does not guarantee me status as an applicant or any consideration of employment unless I meet all stated minimum qualifications required of the position for which I am asking to be considered.

I have read the above statements and accept the same as a condition of my employment with the YMCA.

Please type your full name. This acts as your signature and agreement to the statements above.

5/27/2017 3:27:04 PM