YCS General Employment Application

Name Name * First Last
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone Cell Phone - ### - ### ####
Home Phone Home Phone - ### - ### ####
Email *

Confirm Email Address *
What position(s) would you like to apply for? *

What position(s) would you like to apply for? Clipper Care Clipper Day Camp Counselor Clipper Day Camp Group Leader Theater Camp Counselor Program Leader Basketball Official Other Other
How did you hear about these positions?
List any current certifications you have acquired (Lifeguard, CPR, First Aid, Babysitting, EMT, Bus Driver, etc..)
Please list all job positions you have held within the past five years (include dates of employment along with supervisor's name, phone number, and email address). *
REFERENCE INFORMATION
Reference #1 Name Reference #1 Name * First Last
Relationship *
Phone Phone * - ### - ### ####
Email *
Reference #2 Name Reference #2 Name * First Last
Relationship *
Phone Phone * - ### - ### ####
Email *
Reference #3 Name Reference #3 Name * First Last
Relationship *
Phone Phone * - ### - ### ####
Email *
SCHOOL INFORMATION
High School Name *
Year of graduation or expected graduation
College Name
Year of graduation or expected graduation
College Major
Tell us about any experience you have working or volunteering with children *
Tell us why you would like to work for Yarmouth Community Services *
Town of Yarmouth / Yarmouth Community Services Background Check Authorization
By signing below I understand that in order to assess my qualifications for the position, a full criminal background investigation is necessary. I, therefore, authorize the Town of Yarmouth/Yarmouth Community Services to conduct an investigation in order to obtain information concerning my criminal background.

I understand that a consumer report may be prepared summarizing the above information. I may request a copy of any report that is prepared regarding me from the consumer reporting agency and may also request the nature and substance of all information about me contained in the files of the consumer-reporting agency. I understand that proper identification will be required and that I should direct my request to:

Equifax Credit Information Services, Inc
P.O. Box 740241
Atlanta, GA 30374

I hereby release any individual, entity and the municipality from all claims of liabilities that might arise from the inquiry into or disclosure of such information, including claims under any federal, state, or local civil rights law and any claims for defamation or invasion of privacy.

All the information and materials I have provided to the Town of Yarmouth as part of the employment process are accurate and truthful. I realize that providing the municipality with false information or intentionally withholding relevant information regarding my application may be grounds for dismissal.
Do you agree to allow the Town of Yarmouth / Yarmouth Community Services to conduct a background check on you? *

Do you agree to allow the Town of Yarmouth / Yarmouth Community Services to conduct a background check on you? Yes, I agree No, I do not agree
Your Full Legal Name Your Full Legal Name * First Middle Last
Maiden Name (if applicable) Maiden Name (if applicable) First Middle Last
Date of Birth Date of Birth * / MM / DD YYYY
Certificate of Applicant

Read Carefully Before Signing - I hereby certify that all statements in this application are true and complete and that any misstatement or omission of material facts may subject me to disqualification or dismissal.
Draw your signature into the box below.

Clear

YCS General Employment Application

YCS General Employment Application

REFERENCE INFORMATION

SCHOOL INFORMATION

Town of Yarmouth / Yarmouth Community Services Background Check Authorization

Certificate of Applicant