Employment Application

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Employment Application

YWCA Dayton is an equal opportunity employer. Discrimination against individuals due to race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation or military status is against Agency policy and is expressly prohibited by law. YWCA Dayton is an Equal Opportunity Employer.

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Personal Information
Name
First Middle Last
Current Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Permanent Address (if different than above)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone
Email
Have you ever worked under a different name?
(Required for verifying education, employment records and references.)
Name (if responding Yes to question above)
First Last
Have you ever been convicted of a felony?
A conviction record will not necessarily be a barrier to employment. This information will be used only for job-related purposes and only to the extent permitted by law. Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization within 3 days of hire. Failure to submit such proof within the required time will result in immediate termination of employment.
Please explain if answering Yes to felony question above.

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Employment Desired
Position
Type
What date are you available to start?
MM slash DD slash YYYY
Desired Salary/Hourly Rate
Do you have any relatives who are presently employed by YWCA Dayton?
Name (if responding Yes to question above)
First Last
How did you hear about employment opportunities at YWCA Dayton?
Other:
Have you ever worked at any YWCA?
Prior YWCA employment (if answering Yes to question above)

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Education
High School (Name & Degree Received)
College (Name & Degree Received)
Post-Graduate (Name & Degree Received)
Other (Name & Degree Received)
List specialized training or certifications:

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Employment History
Please include all employment for the last five years. Indicate most recent position first.
Employer
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Type
Immediate Supervisor
First Last
Title
Reason for leaving:
Ending wage/salary:
May we contact this employer for a reference?
If responding No to question above, please explain:
Employer
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Type
Immediate Supervisor
First Last
Title
Reason for leaving:
Ending wage/salary:
May we contact this employer for a reference?
If responding No to question above, please explain:
Employer
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Type
Immediate Supervisor
First Last
Title
Reason for leaving:
Ending wage/salary:
May we contact this employer for a reference?
If responding No to question above, please explain:

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References
List individuals most familiar with your skills and qualifications. Do not list relatives or supervisors already identified on this application.
Name
First Last
Title
Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Years Known
Name
First Last
Title
Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Years Known
Name
First Last
Title
Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Years Known

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Residence Record
Our background check procedures require address records for the last 5 years.
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates (from/to)
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates (from/to)
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates (from/to)

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Authorization for Release of Information
I certify this application was completed by me and the entries contained in this application are true and complete to the best of my knowledge. I understand that misrepresentation or omission of facts requested on this application may be grounds for rejection of this application or dismissal from employment if subsequently discovered. I authorize YWCA Dayton to make inquires which may provide background regarding my character, general reputation, and past work performance. I hereby authorize YWCA Dayton to inquire and also authorize and request each former employer, educational institution, persons, government and law enforcement agencies to answer all questions which may be legally asked, and to release all information which may be legally sought. I hereby release all parties from any liability or responsibility for doing so. I understand that as an applicant for employment with YWCA Dayton, I will be required to undergo drug testing as part of the application process. I further understand that a background investigation will be conducted and may encompass obtaining information from law enforcement agencies, federal and state government agencies. I understand that this employment application and any other YWCA Dayton documents are not contracts of employment. I understand and acknowledge that my employment with YWCA Dayton is not guaranteed for any term and that my employment may be terminated by YWCA Dayton or myself at any time and for any reason. I acknowledge and understand that no management official has any authority to alter my at-will employment status or the policies of YWCA Dayton (with which I agree to comply in consideration of my employment if I am employed) except the chief executive officer who may only do so in writing. If I am hired, I agree to comply with all rules, regulations, and employment policies of YWCA Dayton.
Consent*
I agree to the authorization for release of information .
Please upload a cover letter and résumé.
Drop files here or

Accepted file types: pdf, doc, png, jpg, Max. file size: 2 MB, Max. files: 2.
Email
This field is for validation purposes and should be left unchanged.

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Employment Application

BE SURE TO CLICK THE GRAY “NEXT” BUTTON AT THE END OF EACH PAGE.

Employment Application

Step 1 of 7

Personal Information

Employment Desired

Education

Employment History

References

Residence Record

Authorization for Release of Information