YMCA of Greater Rochester -

Thank you for your interest in working at the YMCA of Greater Rochester.
There are two (2) steps to this application process:

Fill out this application
Print three (3) reference forms (They will also be e-mailed to you)

Personal/Contact Information

First Name:

Last Name:

Middle:

Phone:

Permanent Address:

City:

State:

Zip:

Current Address:
Same as Above

City:

State:

Zip:

Work Preference/Positions:

Select a Camp:

Arrowhead
Bay View
Carlson
Eastside
Lewis Street
Maplewood

Monroe
Northpoint
Southwest
Westside

Minimum Salary:

Dates Available:

From:
To:

Have you ever been employed by the YMCA of Greater Rochester?

Yes No

If yes, which Branch?

Please list any relatives who are employed by the YMCA of Greater Rochester:

Are you over 18?

Yes No

E-Mail Address (for confirmation)

Education/Employment History

Education

School Name & Address From To Course of Study
Diploma/Degree Earned

High School

College/Business
School

Other (Trade,
Technical)

The YMCA of Greater Rochester will not unlawfully discriminate against any applicant because of race, color, creed, national origin, sex, age, marital status or non-qualifying disability.

Employment History: Include recreation, youth work and camp experience.
Please list all general employment and start with present or most recent employer.

Date Employer Name & Address 1. Job Title
2. Supervisor
3. Telephone Major Duties Wages Reason For Leaving

From:
To:    1.
2.
3. Start:
Final:

From:
To:    1.
2.
3. Start:
Final:

From:
To:    1.
2.
3. Start:
Final:

Please identify any other experience working with youth (For example: Babysitting, Scouting and Volunteering)

On the follwing list, check number 1 for those activities that you can organize and teach as an expert; 2 for those that you can assist with teaching and 3 for those that you are interested in learning about.
Camp Crafts 123Hiking 123Outdoor Living Skills 123Overnight Camping 123Other: Challenge Course 123Initiatives/New Games 123Low Ropes Course 123High Ropes Course 123Climbing Tower 123Other: Nature 123Animals 123Astronomy 123Birds 123Conservation 123Flowers 123Forestry 123Insects 123Rocks & Minerals 123Trees & Shrubs 123Weather 123Other:	Waterfront Activities Swimming 123Instructional 123Synchronized 123Diving 123Competitive 123Canoeing 123Rowing 123Sailing 123Windsurfing 123Water-Skiing 123Snorkeling/Skin Diving 123Other: Sports 123Archery 123Fishing Horseback Riding 123Western 123English 123Tennis 123Soccer 123Basketball 123Volleyball 123LaCrosse 123Track & Field 123Baseball 123Other:	Music & Drama 123 Leading Songs 123Instruments 123Guitar 123Drama Games/Activities 123Skits 123Other: Arts & Crafts 123Boondoggle/Lanyards 123Nature Crafts 123Sketching/Drawing 123Woodworking 123Candlemaking 123Other: Miscellaneous 123Storytelling 123Campfire 123Evening Programs 123Photography 123Folk Lore 123Family Programs 123Other:
List other skills/programs you could offer that would be useful in camp.

Please list all certifications below. List the course title, date of issue and training location as they appear on your certification card. (If course is in progress, please indicate course title from registration materials and expected date of completion.) Don't forget to list those courses for which you are at an instructor level. (Only current certifications, please.)
Course	Course Title	Date Completed	Sponsored By
First Aid
CPR
Waterfront
Lifeguarding
Boating
RN/LPN
EMT
Other

Please write a brief biographical sketch including specialized training in camping, and experience in other fields, which might have a bearing on this application.

References (References must be able to comment specifically on applicant's abilities and experiences based on the position. Your references must not be a relative or household member.)
Name	1. Address 2. City/Town 3. Zip	Phone	Position/Occupation	Relationship to Applicant
	1. 2. 3.
	1. 2. 3.
	1. 2. 3.
How did you hear of this opportunity?
Have you had any criminal convictions? (Please describe below) Yes No A "yes" answer will not necessarily disqualify you from consideration.

Please read carefully before submitting your application By submitting this application, I certify that the information I have given on this application is true and complete and is subject to verification by the YMCA. I also understand that any misrepresentation or falsification, regardless of when discovered, may subject me to disqualification for employment or discharge from employment (if I am in fact hired by the YMCA). By submitting this application, I authorize the YMCA to investigate my responses on this application and to contact any or all of the individuals listed in this application and/or any or all of my former employers. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment. Regardless of whether or not I become employed by the YMCA, I recognize that this application is not and should not be considered a contract of employment. I understand that any employment offered is for an indefinite duration and is at-will, and I also understand that this application for employment is good for 90 days only and that consideration for employment after 90 days requires a new application. Check this box to certify that you have read and accept the above statement. You will not be able to submit your application until this box is checked.