Employment Application
Date:
Name:
Address:
State/Province:
Zip/Postal Code:
E-mail Address
Home Phone:
Cell Phone:
Positions Applied for:
Salary Desired:
Hours Available to Work:
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
Full-Time
part-time
Full or part-time
When available to begin work?
Greater Scranton YMCA
706 N. Blakely Street
Dunmore, Pa
USA
18512
Phone: 570-342-8115
Fax: 570-342-8205
www.greaterscrantonymca.com
Education
Type of School
Name of School and Complete Mailing Address
No. Years Completed
Major or Degree
High School
College Bus. or
Trade School
Professional School
Other
Have you ever been convicted of a crime:
yes
no
If yes, please explain
Do you have a drivers license?
yes
no
State of issue:
Have you had any accidents in the past 3 years?
yes
no
How many?
Do you had any moving violations in the past 3 years?
yes
no
How many?
Continue on the next page
Previous Employment (list up to 3)
1.
Name of Employer:
Name of last supervisor:
Dates of employment:
From:
To:
Salary:
From:
To:
Complete Address:
Phone #:
Last job title:
Reason for Leaving (be specific):
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:
May we contact your employer:
yes
no
2.
Name of Employer:
Name of last supervisor:
Dates of employment:
From:
To:
Salary:
From:
To:
Complete Address:
Phone #:
Last job title:
Reason for Leaving (be specific):
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:
May we contact your employer:
yes
no
Continue on the next page
3.
Name of Employer:
Name of last supervisor:
Dates of employment:
From:
To:
Salary:
From:
To:
Complete Address:
Phone #:
Last job title:
Reason for Leaving (be specific):
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:
May we contact your employer:
yes
no
Skills:
Typing:
Computer:
PC
Mac
Both
Applications (list all that apply):
Other Skills:
Please list 2 r