Sioux YMCA Intern, Staff or Volunteer Application

Please submit a resume or other information if you feel it will allow us further insight into your qualifications.

Email or Postal Mail to: Sioux YMCA P.O. Box 218 Dupree, SD 57623

You must answer all questions or your application will be considered incomplete.

Please send a separate email to confirm the arrival of this application: crandall@siouxymca.org

Note that an essay may be required. Please read position announcement carefully.

Please note: If you press the Enter button, this application will be sent.

First Name Last Name

Social Security Number

Current Phone

Current Address Until when?

Permanent Phone

Permanent Address

E-Mail Address

Position Desired

What are your dates of availability?

18 or older? YesNo 21 or older? YesNo

Do you possess a valid driver license? YesNo

If yes, which state? Drivers license #

Are you legally authorized to be employed in the USA? YesNo

Have you ever been convicted of a criminal offense? YesNo

If yes, please explain:

Education Information

What is your present year in school?

If not now in school, what is the last year of high school or college you completed?

School Name, Dates Course of Graduated Degree

City, and State Month/Year Study or Major

High

School

College

Other

Employment History

List all work experience beginning with your current or most recent position. We may contact present or former employers.

Company Name Employed from to

Address (Street, City, State, Zip)

Name of Immediate Supervisor

Title of Immediate Supervisor

Telephone

Your Title

Reason for Leaving

Description of Responsibilities

Company Name Employed from to

Address (Street, City, State, Zip)

Name of Immediate Supervisor

Title of Immediate Supervisor

Telephone

Your Title

Reason for Leaving

Description of Responsibilities

Company Name Employed from to

Address (Street, City, State, Zip)

Name Immediate Supervisor

Title of Immediate Supervisor

Telephone

Your Title

Reason for Leaving

Description of Responsibilities

Why do you want to work / volunteer at the Sioux YMCA?

What do you hope to learn or gain from this position?

How does this position relate to your future plans or goals?

How will you cope with a new culture and the remoteness of the reservation? Have you

ever experienced living in a different culture or remote location?

Personal References

List three individuals able to give character references. You should include employers or teachers, but not your relatives.

Name Work Phone Home Phone

Address

Occupation

Relationship to Applicant

Name Work Phone Home Phone

Address

Occupation

Relationship to Applicant

Name Work Phone Home Phone

Address

Occupation

Relationship to Applicant

Certifications

List all certifications you currently have or will have by the start of employment. Copies will need to be provided upon arrival.

Certification 1 Expiration Date

Certification 2 Expiration Date

Certification 3 Expiration Date

IMPORTANT - PLEASE NOTE

We will conduct criminal and sexual offender background checks on all employees and volunteers. We will also conduct drivers checks and a credit report. Your date of birth will be required at the latter part of the interview process in order to run the background, driving record and credit checks.
YMCA policy requires all staff to have a physical examination within 9 months prior to arrival and to hold current Adult and Child First Aid and CPR certifications.
Use of alcohol and non-prescription drugs is not permitted even if the employee or volunteer is of the legal age. A drug/alcohol pre-employment test is mandatory.
The Sioux YMCA facilities, grounds, programs and activities are alcohol and tobacco-free.

Release and Personal Certification of Application

I understand that this application is only valid for the position applied for at present and that the Sioux YMCA is not obligated to retain or consider this application for future openings.
I agree to submit to legally permissible drug and/or alcohol testing upon request by the Sioux YMCA. I recognize that the results of these tests may be used to determine my employment or continued employment.
If I am employed by the Sioux YMCA I understand my employment can be terminated, with or without cause and with or without notice, at any time at the option of the Sioux YMCA or myself. I understand that only the Executive Director of the Sioux YMCA has the authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing and then only in writing. I further expressly agree that, with respect to the at-will employment relationship, this constitutes the full, complete and final expression of the parties’ intent concerning the nature of any employment relationship between the Sioux YMCA and myself. If offered a position, I will conscientiously abide by all rules and conditions of employment.
I certify that all statements made by me on this application are true to the best of my knowledge and that I have not withheld anything that would, if disclosed, affect this application unfavorably. I understand and agree that any misrepresentation or omission of facts that would exclude my being considered for employment, or after employment, may be cause for termination with the Sioux YMCA.
I grant permission to the YMCA to solicit and investigate statements from any person and/or organization with regard to my personal history and prior employment and agree to hold all persons harmless with respect to the information they may give, receive, or publish. I understand the YMCA will conduct a criminal and a sexual offender background check, a drug/alcohol test, my driving record and possibly a credit check. I hereby waive any right to claim any request or investigation is an invasion of my privacy and will cooperate with any requests for information since they are made with my consent.

I hereby acknowledge that I have read and understand all of the above and that I voluntarily submit this application.