YWCA Job Application" * " indicates required fields Position Applying For * Music Instructor Payment Services Assistant Manager Parent Services Supervisor Fitness Instructor Activity Leader Client Relations Associate Activity Aide STEAM Tutor Family Care Coordinator Curriculum and Family Engagement Director Leisure Leader Lifeguard Specialty Fitness Instructor Payment Services Manager Assistant Director Swim Lesson Instructor Payment Services Coordinator Accountant Outreach Specialist Dance Instructor Leisure Leader Aquatics Trainer Associate Administrator AEL Teacher Teacher Clerk Custodian Educational Programs Coordinator Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Alternate Phone (###) ### #### Type of Employment Required * Full Time Part Time Temporary Seasonal Date MM DD YYYY Email * Are you willing to work flexible hours, which could include weekends and/or overtime? * Yes No Can you perform the essential functions of the job(s) you are applying for with or without reasonable accommodation? * Yes No Are you legally eligible for employment in this country? * Yes No Are you 18 years of age or older? * Yes No Have you, since the age of 18, been convicted of a misdemeanor or a felony or have such pending? Note: A conviction will not necessarily disqualify an applicant from consideration for a particular job. * Yes No If yes, please explain Which of the following languages are you fluent in? * English Spanish Other Have you been employed at the YWCA El Paso before? * Yes No If you have been employed with this company before, when and what location? Please select below how you heard about us. * Indeed.com Educational Institute UTEP Job Fair FT Bliss Hiring Fair YWCA Employee Friend or Relative Social Media Military TWC Housing Walk In Advertisement Snag A Job Jora Learn 4 Good Craigslist Other If referred by employee, list first and last name below. Educational Background: List previous 3 educational institutions attended, starting with the most recent School #1 * City, Province/State * Graduated? * Yes No Years Completed: * Degree(s)/Diploma(s) Earned/Attempted * School #2 * City, Province/State * Graduated? * Yes No Years Completed: * Degree(s)/Diploma(s) Earned/Attempted * School #3 * City, Province/State * Graduated? * Yes No Years Completed: * Degree(s)/Diploma(s) Earned/Attempted * Employment Background: Begin with most recent employer Employer #1 * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Job Title * Dates Employed (From-To) * Immediate Supervisor and Title * Reason for Leaving * May we contact for reference? * Yes No Later Summarize the type of work performed and job responsibilities * Starting Rate/Salary ($) Per Hour Week Month Year Ending Rate/Salary ($) Per Hour Week Month Year Employer #2 * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Job Title * Dates Employed (From-To) * Immediate Supervisor and Title * Reason for Leaving * May we contact for reference? * Yes No Later Summarize the type of work performed and job responsibilities * Starting Rate/Salary ($) Per Hour Week Month Year Ending Rate/Salary ($) Per Hour Week Month Year Employer #3 * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Job Title * Dates Employed (From-To) * Immediate Supervisor and Title * Reason for Leaving * May we contact for reference? * Yes No Later Summarize the type of work performed and job responsibilities * Starting Rate/Salary ($) Per Hour Week Month Year Ending Rate/Salary ($) Per Hour Week Month Year References: List names and telephone numbers of business references who are not related to you Reference #1 Name * First Name Last Name Relationship * Years Acquainted * Phone Number * (###) ### #### Email Reference #2 Name * First Name Last Name Relationship * Years Acquainted * Phone Number * (###) ### #### Email Attestation Statements - I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for YWCA to hire me. If I am hired, I understand that either YWCA or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of YWCA has the authority to make any assurance to the contrary. * I Understand Type your initials * I attest by selecting the box below and including my initials that I have given to YWCA true and complete information on this application. No requested information has been concealed. I authorize YWCA to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal. * I Understand Type your initials * Copies of College Transcripts/GED Certificate/ High School Diploma may be submitted with the application. If you are selected for an interview, you will be required to submit these documents by the interview date. As part of your application for employment with YWCA, please read and complete the form below! Self Identification EEO-1 Self-Identification Form; responses are used to complete the Department of Labor EEO Reporting The employer is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, the employer invites employees to voluntarily self-identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. We also comply with government regulations including but not limited to affirmative action responsibilities as required under Executive Order 11246, Section 503 of the Rehabilitation Act of 1973, Section 4212 of the Vietnam Era Veterans Readjustment Act of 1974 and Veterans Employment Opportunities Act (VEOA) of 1998. This data is for periodic government reporting and will be kept in a confidential file separate from the application for employment and employee file. Name * First Name Last Name Date * MM DD YYYY Gender * Female Male Prefer not to answer Other Job Title (If applicable) Race/Ethnicity * Please select the option below corresponding to the ethnic group with which you identify Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin) White (a person having origins in any of the original peoples of Europe, the Middle East, or North Africa) Black or African American (a person having origins in any of the black racial groups of Africa) Native Hawaiian or Other Pacific Islander (a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands) Asian (a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, for example: Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam) American Indian or Alaska Native (a person having origins in any of the original peoples of North and South America, including Central America, and who maintains tribal affiliation or community attachment) I do not wish to self-identify Veteran Status * I am not a veteran Yes, I am a veteran Disability- Do you have a disability? * Yes No Do not wish to respond Veteran Self-Identification Form 100; responses are used to complete the required VETS-100 Reporting Name First Name Last Name Date MM DD YYYY Position Employed In or Applying For Are you a veteran? Yes No If yes, what is your date of discharge? MM DD YYYY Are you retired from the military? Yes No If yes, what is your date of retirement? MM DD YYYY Are you a disabled veteran? Yes No Are you a veteran of the Vietnam era? Yes No Are you another protected veteran? (Veteran who served on active duty in the US military during a war or in a campaign or expedition for which a campaign badge is awarded) Yes No Are you a recently separated veteran? (Veteran within 12 months from discharge or release from active duty) Yes No Do you qualify for Veteran's Preference? (The last war for which active duty is qualifying for veteran's preference is World War II (12-7-41 thru 4-28-52) Yes No If yes, please explain Disabled Veteran means: 1‐ A Veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans' Affairs for a disability (A) rated at 30 percent or more, or (B) rated at 10 or 20 percent in the case of a Veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap 2‐ A person who was discharged or released from active duty because of a service‐connected disability. Veteran of the Vietnam era means: A person who: 1‐ Served on active duty in the U.S. military, ground, naval or air service for a period of more than 180 days and who was discharged or released with other than a dishonorable discharge, if any part of such active duty was performed: (A) In the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) Between August 5, 1964, and May 7, 1975, in all other cases. 2‐ Was discharged or released from active duty in the U.S. military, ground, naval or air service for a service‐connected disability if any part of such active duty was performed: (A) In the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) Between August 5, 1964, and May 7, 1975, in any other location. Other protected Veteran means: Veterans who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the U.S. Department of Defense. Recently separated Veteran means: Any Veteran during the three‐year period beginning on the date of such Veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service. Armed Forces Service Medal Veteran means: Any Veteran who, while serving on active duty in the U.S. military, ground, naval, or air service, participated in a United States military operation to which an Armed Forces Service Medal was awarded pursuant to Executive Order 12985. Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005 Expires 05/31/2023 Why are you being asked to complete this form? We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years. Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. How do you know if you have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Autism, Autoimmune disorder (for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS), Blind or low vision, Cancer, Cardiovascular or heart disease, Celiac disease, Cerebral palsy, Deaf or hard of hearing, Depression or anxiety, Diabetes, Epilepsy, Gastrointestinal disorders (for example Crohn's Disease, or irritable bowel syndrome), Intellectual disability, Missing limbs or partially missing limbs, Nervous system condition (for example migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS)) Psychiatric condition (for example bipolar disorder, schizophrenia, PTSD, or major depression) Please check one of the boxes below Yes. I have a disability, or have a history/record of having a disability No. I don't have a disability, or a history/record of having a disability I don't wish to answer PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete. Thank you!
