Postion:

Branch:

How did you hear about this position? Volunteer
Newspaper
Friend
YMCA Member
Other

Personal Information

First Name:

Initial:

Last Name:

Address:

City:

Postal Code:

Email:

Home Phone:

Cell Phone:

Emergency Contact Information

Name:

Phone:

Relationship:

Availability

Monday: Morning
Afternoon
Evening

Tuesday: Morning
Afternoon
Evening

Wednesday: Morning
Afternoon
Evening

Thursday: Morning
Afternoon
Evening

Friday: Morning
Afternoon
Evening

Saturday: Morning
Afternoon
Evening

Sunday: Morning
Afternoon
Evening

Personal Interest

Please check the area(s) of interest:

Fitness
Aquatics
Babysitting
Child Care
Facility Maintenance
Management Committee
Community Programs
Youth&Teen Programs
Racquet Sports
Weight Training

What interested you in becoming a volunteer with the YMCA?

Skills, Hobbies, Interests or Degrees:

Have you been previously involved with the YMCA? Yes
No

If Yes, Where:

When:

How Long:

Education

High School:

University:

Business/College:

Other/Related:

History (Volunteer or Employment)

Employer 1:

Your Title:

Duties:

Supervisor:

Phone:

Your Title:

Date of Position:

Reason for Seeking Other Position:

Surpervisory Responsibilites? Yes
No

Employer 2:

Your Title:

Duties:

Supervisor:

Phone:

Your Title:

Date of Position:

Reason for Seeking Other Position:

Surpervisory Responsibilites? Yes
No

Employer 3:

Your Title:

Duties:

Supervisor:

Phone:

Your Title:

Date of Position:

Reason for Seeking Other Position:

Surpervisory Responsibilites? Yes
No

References

You may give additional references, if you wish (business associates, teachers or professors preferred:

I authorize you to obtain references from my past & present employers/supervisors.

Name 1:

Address:

Phone:

Years Known:

Name 2:

Address:

Phone:

Years Known:

I certify that the statements made by me in this application are true and complete. I also understand and agree that a false statement may disqualify me from a position or result in dismissal.