Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome PhoneCell PhoneEmail *Are you at least 14 years old? *YesNoAre you a citizen of the United States? *YesNoIf no, are you authorized to work in he U.S.?YesNoHave you ever worked for this company?YesNoIf so, when and what were your duties?Have you ever been convicted of a felony? *YesNoIf yes, explain:Previous Employment1. Company:Address:PhoneSupervisorFirstLastJob TitleDates of EmploymentReason for leaving:May we contact your previous supervisor for a reference?YesNo2. Company:Address:PhoneSupervisorFirstLastJob Title:Dates of EmploymentReason for leaving:May we contact your previous supervisor for a reference?YesNoMisc.Have you ever been fired from a job:YesNoWhy were you fired:How did you hear about this Job:Any Job limitations we need to know about: YesNoIf so what?ReferencesName *FirstLastRelationship:Company:PhoneAddress:Name *FirstLastRelationship:Company:PhoneAddress:Contact & Emergency Contact Info1. Parent/Guardian/OtherAddress:Phone:Relationship:2. Parent/Guardian/OtherAddress:Phone:Relationship:Job InterestWhat jobs are you interested in: (Check all that apply)Life GuardFood & Retail SalesBeach Admission/EntryFirst AidLawn CareMinor CarpentryAny OpeningsCurrent Certifications (List current certifications, including lifeguarding, first aid and CPR/AED certifications; a copy of each certification will be required)List Certifications, where obtained & expiration date:Lifeguard/Swimming Back GroundDescribe your lifeguarding experience:What do you consider to be your strengths as a lifeguard?What do you consider to be your weakness as a lifeguard?What is your personal swimming background? (weak, moderate, strong swimmer)Schedule AvailabilityMay - Check (X) days you CANNOT work. Open days indicate you are able to work.MondayTuesdayWednesdayThursdayFridaySaturdaySundayJune - Check (X) days you CANNOT work. Open days indicate you are able to work.MondayTuesdayWednesdayThursdayFridaySaturdaySundayJuly - Check (X) days you CANNOT work. Open days indicate you are able to work.MondayTuesdayWednesdayThursdayFridaySaturdaySundayAugust - Check (X) days you CANNOT work. Open days indicate you are able to work.MondayTuesdayWednesdayThursdayFridaySaturdaySundayScheduling information1. Let us know of any dates you have for vacation, holiday plans, leaving for school etc. (This is just to help us plan, we of course understand things will come up & plans change)2.3.4.DISCLAIMER AND SIGNATUREI certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. By typing my full name in the box below to signing this form electronically. *WebsiteSubmit Total Page Visits: 6628 - Today Page Visits: 3