Name *

First

Last

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Home Phone

Cell Phone

Email *

Are you at least 14 years old? *

• Yes
• No

Are you a citizen of the United States? *

• Yes
• No

If no, are you authorized to work in he U.S.?

• Yes
• No

Have you ever worked for this company?

• Yes
• No

If so, when and what were your duties?

Have you ever been convicted of a felony? *

• Yes
• No

If yes, explain:

Previous Employment

1. Company:

Address:

Phone

Supervisor

First

Last

Job Title

Dates of Employment

Reason for leaving:

May we contact your previous supervisor for a reference?

• Yes
• No

2. Company:

Address:

Phone

Supervisor

First

Last

Job Title:

Dates of Employment

Reason for leaving:

May we contact your previous supervisor for a reference?

• Yes
• No

Misc.

Have you ever been fired from a job:

• Yes
• No

Why were you fired:

How did you hear about this Job:

Any Job limitations we need to know about:

• Yes
• No

If so what?

References

Name *

First

Last

Relationship:

Company:

Phone

Address:

Name *

First

Last

Relationship:

Company:

Phone

Address:

Contact & Emergency Contact Info

1. Parent/Guardian/Other

Address:

Phone:

Relationship:

2. Parent/Guardian/Other

Address:

Phone:

Relationship:

Job Interest

What jobs are you interested in: (Check all that apply)

• Life Guard
• Food & Retail Sales
• Beach Admission/Entry
• First Aid
• Lawn Care
• Minor Carpentry
• Any Openings

Current 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 Ground

Describe 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 Availability

May - Check (X) days you CANNOT work. Open days indicate you are able to work.

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• Sunday

June - Check (X) days you CANNOT work. Open days indicate you are able to work.

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• Sunday

July - Check (X) days you CANNOT work. Open days indicate you are able to work.

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• Sunday

August - Check (X) days you CANNOT work. Open days indicate you are able to work.

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• Sunday

Scheduling information

1. 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 SIGNATURE

I 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. *

Name

Submit

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