Employment Application

Work History

List present or most recent job first. You may include in your work history any work performed on a volunteer basis.

Company Name *

Start Date of Employment *

End Date of Employment *

Most recent title *

Company Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reason for Leaving *

Rate of Pay

Company Name

Start Date of Employment

End Date of Employment

Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Most recent title

Reason for Leaving

Rate of Pay

Company Name

Start Date of Employment

End Date of Employment

Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Most recent title

Reason for Leaving

Rate of Pay

REFERENCES

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Relationship *

How long have you known this person? *

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Relationship *

How long have you known this person? *

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Relationship *

How long have you known this person? *

Please describe any job-related skills or training not mentioned above

PLEASE READ CAREFULLY AND SIGN THE STATEMENT BELOW: *

I certify that the information given above is true and complete and I understand that misrepresentation and/or withholding of information will result in the rejection of this application or my discharge if discovered after employment begins. I authorize the Somerville YMCA to make inquiries regarding my work or educational history and the character of my prior employers, schools, etc. I hereby release employers, schools or individuals from all liability in responding to inquiries in connection with my application and release the Somerville YMCA from all liability with respect to such inquiries. I understand that no verbal promises or guarantees relating to employment are binding upon the Somerville YMCA and that, if employed, I will be an employee “at will” and may be discharged at any time for any reason, with or without cause.

Applicant’s Signature *

Clear Signature

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. The Somerville YMCA is an Equal Opportunity Employer.

Date / Time *

Date

Time

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EDUCATION

Work History

REFERENCES

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EDUCATION

Work History

REFERENCES

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