Rye YMCA Volunteer Application

Rye YMCA

Volunteer Application

Name:

Date:

Address:

Telephone

Home:
Work:

Are you 18 years of age or over?

Yes
No

What department(s) would you like to volunteer for?

AquaticsChild CareAdult Fitness
Youth SportsGymnasticsTeen Programs
Summer CampSpecial EventsAdministration

Please Indicate days available to work:

Why are you interested in volunteering at the Rye YMCA?

General Information

Please give a brief history of any past volunteer experience(s) you may have:

Have you ever volunteered for a YMCA before?

Yes
No

If yes, which YMCA?

Date(s)

Position(s) held?

What were your responsibilities?

Name of Supervisor:

Phone

Have you ever plead guilty or been convicted of a criminal offense?

Yes
No

If yes, give dates and circumstances:

Employment Reference Information

Two references are required.

Note: If you do not have employment references, please list two personal references.

Name of Company:			Dates of Employment:
Position(s) Held:			What were your responsibilities?
Name of Supervisor:			Title:
Company Address:			Company Phone Number:

Name of Company:			Dates of Employment:
Position(s) Held:			What were your responsibilities?
Name of Supervisor:			Title:
Company Address:			Company Telephone Number:

Special Skills / Interests

Please List all current special skills, certifications, training, etc., that you have that would assist you as a volunteer at the Rye YMCA:

Volunteer Statement: I hereby state that all of the information that I have submitted in this application is current and true to the best of my knowledge.

Name:

Date: