Form — Application for Employment | YWCA West Central Michigan

Date *

Name *

First Middle Last

Are you legally eligible to be employed in the United States? *

Yes
No

Are you at least 18 years or older? *

Yes
No

(If no, you may be required to provide authorization to work)

Contact Telephone *

Contact Email *

Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

For which position are you applying? (Please be specific) *

Availability *

Full-time
Part-time

Hours available *

Date Available *

Minimum salary requirement *

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? *

Yes
No

(If you have any question as to what functions are applicable to the position for which you are applying, please ask the interviewer before you answer this question)

If no, please explain. *

Have you ever applied for employment at the YWCA West Central Michigan before? *

Yes
No

If so, when and for which position? *

How or by whom were you referred to the YWCA West Central Michigan? *

It is the policy of the YWCA that individuals serving as an employee, intern, or volunteer have not been a service recipient of the organization within the last year. The YWCA does have exceptions to this policy for certain program areas. If you have questions about your eligibility in this regard, please inquire with the YWCA Human Resource Department at (616) 459-4681.

Education

Please check all levels of education completed.

High School

9
10
11
12

College

1
2
3
4

Graduate Degree

Graduate Degree

Please provide the name and address of the school, college or university you attended. *

Dates attended

From (mm/yy) to (mm/yy)

Major Area of Study

Degree or Title Earned

If you attended more than one school, college or university to attain your degree or title, please complete the additional information here.

Please provide the name and address of the school, college or university you attended. *

Dates attended

From (mm/yy) to (mm/yy)

Major Area of Study

Degree or Title Earned

Are you a licensed or registered member of any trade or profession relevant to this position? *

Yes
No

Type of license or registration *

Registration, Certification or License Number *

In which state? *

Current Employment

(Please include relevant internship or volunteer information.

Name of current employer *

Employment Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Supervisor *

First Last

Phone *

What is your title? *

What are your responsibilities? *

Hire Date *

Starting salary *

Current salary *

Why are you seeking other employment? *

May we contact your current employer? *

Yes
No

May we contact you at your current job? *

Yes
No

Previous Employment

Name of Employer

Employment Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Supervisor

Phone

What was your title?

What were your responsibilities?

Dates of employment

From (mm/yy) to (mm/yy)

Starting salary

Ending salary

May we contact this employer?

Yes
No

Why did you leave?

Name of Employer

Employment Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Supervisor

Phone

What was your title?

What were your responsibilities?

Dates of employment

From (mm/yy) to (mm/yy)

Starting salary

Ending salary

May we contact this employer?

Yes
No

Why did you leave?

Name of Employer

Employment Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Supervisor

Phone

What was your title?

What were your responsibilities?

Dates of employment

From (mm/yy) to (mm/yy)

Starting salary

Ending salary

May we contact this employer?

Yes
No

Why did you leave?

Criminal History

A conviction record will not necessarily be a bar to employment. Factors such as age and time of the offense, seriousness and nature of violation, rehabilitation, employment record, and nature of job applying for will be taken into account.

Have you ever been convicted of a crime (including misdemeanors) or violation other than a minor traffic infraction? *

Yes
No

If yes, please describe the conviction: *

Have you ever been convicted of child abuse or neglect? *

Yes
No

If yes, please describe the conviction: *

Have you resided, worked, or attended school outside of the state of Michigan at any time during the last ten years?

Yes
No

If yes, list all applicable states/territories/countries: *

Please provide information regarding your skills related to the position for which you are applying. Include information pertaining to internships and/or volunteer activities. *

I certify that the information provided on this application for employment and accompanying resume or other document, if any, is true and complete to the best of my knowledge. *

Yes

Upload resume, cover letter, and any supporting documents

Drop files here or

Accepted file types: pdf, doc, jpg, Max. file size: 4 MB.

The mission of the YWCA West Central Michigan is to eliminate racism, empower women and girls, and promote peace, justice, freedom and dignity for all.

Applicant Certification

I certify that the information provided on the application for employment, intern or volunteer (and accompanying resume or other document, if any) is true and complete to the best of my knowledge.

I hereby authorize persons, schools, my current employer (if applicable), previous employers and other organizations to provide the YWCA West Central Michigan with any requested information regarding my application or suitability for employment. I release, from all liability or responsibility, any person or business requesting or supplying such information.

I understand that my employment, intern, or volunteer relationship with the YWCA West Central Michigan may be terminated by the Association or by me, at will, with or without cause and with or without notice.

I further understand and agree that no manager, supervisor or representative of the YWCA West Central Michigan, other than the CEO, has the authority to enter into any agreement for employment, internship, or volunteering for any specified period of time. I understand that in order to be considered binding, such an agreement must be in writing and signed by both the CEO and by me.

Signature of applicant *

Date *

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Form — Application for Employment

Education

Current Employment

Previous Employment

Criminal History

Applicant Certification