APPLICATION FOR EMPLOYMENT

York Jewish Community Center

2000 Hollywood Drive, York PA 17403
(717) 843-0918 ~ www.yorkjcc.org

The York Jewish Community Center shall not discriminate because of race, color, gender, age, veteran status,
marital status, sexual orientation, national origin, religion, disability, as well as any other characteristic protected by Date:
law. No question on this application is intended to secure information to be used for such discrimination.
First Name: Middle Name: Last Name:

Home/Cell Phone: Email Address:

Street: City/State/Zip:

Notify in case of emergency: Phone:

POSITION APPLYING FOR: (see list below). Check other interest(s):

 Accounting  Clerical  Lifeguard  School for the Early Years

 Aerobics  Cultural  Maintenance/Housekeeping  Summer Camp

 Aquatic Fitness  Diversity  Nursery  Swim Instructor

 Art Instructor  Fitness Center Instructor  School Age Child Care  Youth Lounge

 Child Care  Front Desk  Other:

Position Type:  FT  PT Hours Available: Expected Pay Rate:

Date you can begin work: How were you referred to us?

Have you worked here before?  Yes  No If yes, When: Position:

Have you ever been convicted of a misdemeanor or a felony? Yes  No If yes, describe in full:

EDUCATION OR TRAINING EXPERIENCE (include Military Service):

Highest grade or degree in school: Course of study:

School: Address:

Special Training:

Where Received:

Other Special Skills:

Describe how you feel your education/experience will contribute to the position for which you are applying:
PREVIOUS EMPLOYERS (most recent first) Please give accurate, complete full-time and part-time employment.

Company Name: Address:

Position Held: Dates Worked: From: to:

Duties / Responsibilities:

Supervisor: May we contact your Supervisor?  Yes  No

Reason, if No:

Phone: Salary when you left: Reason for leaving:

Company Name: Address:

Position Held: Dates Worked: From: to:

Duties / Responsibilities:

Supervisor: May we contact your Supervisor?  Yes  No

Reason, if No:

Phone: Salary when you left: Reason for leaving:

Company Name: Address:

Position Held: Dates Worked: From: to:

Duties / Responsibilities:

Supervisor: May we contact your Supervisor?  Yes  No

Reason, if No:

Phone: Salary when you left: Reason for leaving:

OTHER REFERENCES (2 professional, 1 personal):

Name Address/City/State/Zip Telephone Years Known

 Personal
 Professional
 Personal
 Professional
 Personal
 Professional

I certify that the above information is correct and that any misrepresentation or omission on this application will be cause for
cancellation of the application or discharge from the Center’s employ, if I have been hired.

Signature: Date:

Mission of the York Jewish Community Center

Our mission, as a premiere Jewish Community Center, is to strengthen and preserve Jewish culture, promote respect for diversity, support the
State of Israel and World Jewry, and enhance the well-being of our members and the communities we serve through cultural, educational,
recreational, social, wellness and child development opportunities.
 EMPLOYMENT INQUIRY RELEASE
In connection with your application for employment with the York Jewish Community Center (JCC), we will make inquiries, including but not limited
to, education, professional licensing, criminal history, driving history, your personal character, abilities, work habits, residency, immigration status,
general reputation, performance, experience and other qualities pertinent to your qualifications for employment, including reasons for termination
of past employments.
In compliance with the Fair Credit Reporting Act, you are entitled to be informed if an offer of employment is withheld because of information
obtained from these inquiries and, in that event, upon your written request, we will provide a copy of the written findings that we receive and the
FTC notice, “A Summary of Your Rights Under the Fair Credit Reporting Act”.
Please complete and sign the form which follows, authorizing, without reservation, any party, including, but not limited to, employers, consumer
reporting agencies, law enforcement agencies, state agencies, institutions and private information bureaus or repositories, contacted by us to furnish
any or all of the above mentioned information. Your authorization releases the JCC from any and all liability for damages arising from the
investigation and disclosure of the requested information. Further, it releases and discharges all liability from all companies, agencies, officials,
officers, employees and other persons, who, in good faith, provide to the JCC the above mentioned information as requested, in order to successfully
complete a background investigation for your application for employment. Your signature allows a photocopy or fax copy of this authorization to be
as valid as the original.

Print Full Name:

Street Address: City/State/Zip:

Maiden Name: Other Names Used:

Driver’s License #: Applicant Signature:

FOR OFFICE USE ONLY

References contacted:

Name: Date: Contacted by:

Comments:

Name: Date: Contacted by:

Comments:

Name: Date: Contacted by:

Comments:

Offer extended by: Date:

Position: Starting Date:

Supervisor: Salary: