Greater Pittston YMCA

10 North Main Street

Pittston, PA 18640

Phone: 570-655-2255

Fax:     570-655-5110

 

Application for Employment

First Name___________________________  Last Name______________________________ MI_________

 

Home Address:___________________________________________________________________________

 

City___________________________________  State______________  Zip_________________

 

Home Phone___________________________________  Cell Phone________________________________

 

Social Security #_________________________________  Date of Application_______________________

 

 

If you are under 18 years old, can your provide required proof of

eligibility to work?                                                                                                     ____ Yes  ____ No

 

Have you ever filed an application with us before                                                  ____ Yes  ____ No

 

Have you ever been employed with us before?                                                        ____ Yes  ____ No

If yes, when?_________________ what position?___________________________

 

Are you currently employed?                                                                                     ____ Yes  ____No

 

May we contact your present employer?                                                                   ____ Yes  ____No

 

Are you prevented from lawfully becoming employed in this country because

Of Visa or Immigration Status                                                                                    ____ Yes  ____No

(Proof of citizenship or immigration status will be required upon employment)

 

On what date would you be available to begin working?                                          ______________

 

Are you available to work  ____ Full Time  ____Part Time  ____Shift Work  ____Temporary

 

Are you currently on “lay-off” status and subject to recall by another employer  ____ Yes  ____ No

 

Can you travel if a job requires it?                                                                           ____ Yes  ____ No

 

Have you been convicted of a felony within the last 7 years?                                 ____ Yes  ____ No

(Conviction will not necessarily disqualify an applicant from employment)

 

If yes to above question, please explain______________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

 

If hired at the Greater Pittston YMCA you will be required to complete a Child Abuse/Criminal Background Check and pay a $10 fee.  Do you agree to complete this paperwork and pay the fee?

                                                                                                                                  ____ Yes  ____ No