YWCA OF LUBBOCK

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					                       YWCA OF LUBBOCK
                            Application for Employment
Position:                                                                                       Today’s Date:
Where did you learn about this position?:                                                       Available Start Date:

PERSONAL INFORMATION
Name:                                                                               Cell Phone:
Current Address:                                                                    Home Phone:
City, State, Zip:                                                                   Other Phone:
If you have worked for the YWCA before, list dates and position:



Is any additional information relative to change of name, use of an assumed name, or a nickname necessary to check on your work
record?  Yes  No           If yes, explain.
Do you possess a valid driver’s license?  Yes  No
Are you a citizen of the United States?  Yes  No
If no, do you have the legal right to remain permanently in the United States?  Yes  No
How long have you been a resident of Lubbock?                        How long have you been a resident of Texas?

EDUCATION
                      School                         City, State            #Yrs Attended             Major Area of Study                Degree
 High
 School:
 College:

 Graduate
 School:
 Technical/
 Business:

CERTIFICATIONS
             Course                                                Certifier and Date                                       Expiration Date
 First Aid
 CPR
 EMT
 Lifeguarding
 Water Safety Instructor
 Teacher/Coach
 Ropes Course Instructor
 Other:

ADDITIONAL TRAINING
Please list special skills and/or training that would enhance your candidacy for this position. (For example, office/clerical applicants should
list computer and software training and experience, etc.; childcare applicants should list music, art, sports, etc.)
                    Skill                                                        Training Experience




                                                                                                                                YWCA Application
                                                                                                                                Revised June 2009
ACTIVITIES
Briefly summarize community, school, or other experiences that will enable you to carry out the responsibilities of the job you are seeking,
including working with children if applicable.
                Experience                                                     Purpose, Role, and Results




EMPLOYMENT EXPERIENCE
List most recent experience first.
 Employer’s Name and Address:                    Position/Major Responsibilities:                           Dates Employed
                                                                                                            From:              To:

                                                                                                            YWCA may contact? YES NO
 Employer’s Phone Number:                        Reason for Leaving:                                        Supervisor’s Name and Phone #
                                                                                                            (include area code)



 Employer’s Name and Address:                    Position/Major Responsibilities:                           Dates Employed
                                                                                                            From:              To:

                                                                                                            YWCA may contact? YES NO
 Employer’s Phone Number:                        Reason for Leaving:                                        Supervisor’s Name and Phone #
                                                                                                            (include area code)



 Employer’s Name and Address:                    Position/Major Responsibilities:                           Dates Employed
                                                                                                            From:              To:

                                                                                                            YWCA may contact? YES NO
 Employer’s Phone Number:                        Reason for Leaving:                                        Supervisor’s Name and Phone #
                                                                                                            (include area code)




REFERENCES
List three persons NOT related to you who can judge your qualifications for this position.
           Name and Position                            Address                       Phone Number                   Office Use Only
 1.



 2.



 3.




                                                                                                                             YWCA Application
                                                                                                                             Revised June 2009
WORK SCHEDULE
         Day of the Week                                Part-Time                                        Full-Time
                                            (indicate hours available to work)               (indicate hours available to work)
Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday


Why would you like to have this position?




What do you feel best qualifies you for this position?




Do you know of any reason you would not be able to perform the essential functions of the job position for which you are applying,
with or without reasonable accommodation?  Yes  No If yes, what accommodations might be necessary?

Please read the following statements closely.
 I hereby guarantee the completeness and correctness of the information shown on this application.
 If employed, any misstatement or omission of facts may result in my dismissal.
 I understand and authorize the YWCA to conduct a background check in connection with this application for employment.
    Data obtained will be kept confidential.
 I understand that this application is not an employment contract.



                               Signature of Applicant                                                      Date




Permanent Address (if different from Current):

Street Address                                                                   Phone Number

City                                                                             State                    Zip




                                                                                                                    YWCA Application
                                                                                                                    Revised June 2009

				
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posted:10/1/2012
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