*First Name: MI: *Last Name:

Temporary (Present) Address:

Permanent / Home Address:

Where did you hear about this job opening?:
This Website Google Friend Other

Will you be 18 years of age or older on June 1st, 2011?:
Yes No If not, state your age:

Will you be 21 years of age or older on June 1st, 2011?:
|Yes No

If hired, can you furnish proof that you can legally work in the U.S.?:
Yes No

Do you have a current driver’s license?:
Yes No State: Lic#:

Do you smoke?: Yes No

Please check which camps you are applying to:

McAlister Village - Summer camp kids ages 6 to 12 co-ed.


Talcott Village - Summer camp kids ages 12 to 15 co-ed.


Greenkill - Year-round camp programs for children ages K-8.

Outdoor Education Program Instructor jmarker@ymcanyc.org
Summer Day Camp Counselor
Female Cabin Counselor for sports camps
(June 27 to August 13)
Kitchen Aid
Store Manager

Are you available for the entire camp season (see dates above)?:
Yes No Available dates:

PLEASE ANSWER ALL QUESTIONS

Why do you want to work at summer camp?

Detail your experiences working with children.

What are your strongest qualities?

Why should you be hired for this position?

Most Bizarre thing you have ever taught!

Any other Talents?

Please list any skills or certifications (first aid, lifeguard, 2nd language, computer etc) - and your level of skill, certifications achieved, certifying agency, and expiration date.

Education

List education, formal training licenses, certificates, and degrees related to the position sought.

High School
Name and address of school (indicate city and state):

Course of study / Degree received:

Check last year completed:
9 10 11 12

Junior College
Name and address of school (indicate city and state):

Course of study / Degree received:

Check last year completed:
1 2

College
Name and address of school (indicate city and state):

Course of study / Degree received:

Check last year completed:
1 2 3 4

Business, Trade, Night
Name and address of school (indicate city and state):

Course of study / Degree received:

School or Other
Name and address of school (indicate city and state):

Course of study / Degree received:

PLEASE PLACE APPROPRIATE NUMBER BY EACH ACTIVITY

1 Able to teach / lead     2 Able to assist     3 Vaguelly recall seeing it somewhere

Employment History

Any pending criminal actions:
Yes No

If yes, state when, where, and the nature of such action.

Have you ever been convicted of a felony:
Yes No

If yes, state when, where, and the nature of such conviction. Conviction of an offense is not an automatic bar to employment - all circumstances will be considered, including the nature of the crime and the length of time since conviction.

APPLICANT: PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING THIS APPLICATION FORM.

1. I authorize the YMCA of Greater New York to obtain information concerning former employers and others, and I release all concerned from any liability in connection therewith.
2. I declare that my answers to the questions in this application are true and complete to the best of my knowledge and belief. I understand that any false statements, or omissions of facts called for, appearing on this or any other employment form will be sufficient reason not to hire me, and if discovered after my employment, may result in immediate dismissal at the YMCA of Greater New York’s sole discretion.
3. If employed, I will abide by the rules, regulations, and statements of policy which now exist, or which may, from time to time, be added to, modified, or changed, as circumstances warrant, at the sole discretion of the company.
4. I understand that this application for employment is not a contract and is not intended to confer or create contractual rights of any kind or nature. If employed, employment is on an at-will basis and may be terminated any time and for any reason, with or without cause, by either the employee or the YMCA of Greater New York unless I and an authorized officer of the YMCA of Greater New York have signed a separate and written contract to the contrary.
5. Please note that an employment offer and your continued employment with the YMCA of Greater New York are contingent upon your background check and drug test.

This is to inform you as part of our procedure for processing your application based on information herein; an investigative report may be made whereby information is obtained through personal interviews with third parties.

* I HAVE READ AND UNDERSTAND THE ABOVE.