Work At The Y – Southeastern Indiana YMCA

First Name *

Last Name *

Address *

City *

State *

ZIP Code *

Email *

Phone Number *

Position(s) Desired *

Salary or Hourly Rate Expected *

Availability (Days and Hours) *

Are you legally authorized to work in the United States? *

Yes
No

Will you now or in the future require sponsorship for employment visa status (e.g. H-1B visa status)? *

Yes
No

Are you 18 years old or older? *

Yes
No

Do you have a high school diploma? *

Yes
No

Have you been convicted of or pled guilty or no contest to a felony or misdemeanor other than a minor traffic-related infraction? *

Yes
No

A conviction or plea will not necessarily disqualify you from consideration for employment. However, failure to disclose this information will disqualify you from consideration for employment or will result in termination of employment.

List any special job-related skills, degrees, software, machines, tools, certifications, and any other qualifications that are relevant to the position you are applying for at our Y. *

Electronic Signature *

Email *

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