Name: first m. last Date of Birth: m/d/y / / Address: street city state zip-code Phone: home cell / alternate Email: Please tell us how may we best get in contact with you?: home number cell / alternate email
What position(s) are you applying for?: (please select any and all that may apply)
Lifeguard Pool Attendant Swim Instructor Pool Manager Pool Maintenance
Available for employment: m/d/y / / Last day to work: m/d/y / /
Lifeguarding? Yes No... Certificate expiration date: m/d/y / /
CPR for the Professional Rescuer? Yes No... Certificate expiration date: m/d/y / /
First Aid? Yes No... Certificate expiration date: m/d/y / /
High School: name city state
(please select highest level COMPLETED) 9 10 11 12 GED
College: name city state
major minor grad. date m/y /
Vocational, special training, and/or notable skills: please list & describe below
Service & achievement awards: please list & describe below
Extracurricular sports and activities: please list & describe below
Employer #1: name phone #
Address: street city state zip-code
Employed from: m/y / until / Final pay: salary / hourly rate
Supervisor: name(s)
Job duties: please list & describe below
Employer #2: name phone #
Employer #3: name phone #
Reference #1: name title
Phone: primary alternate Relationship:
Reference #2: name title
Reference #3: name title
Comments & questions : please address anything that you feel has not been adequately covered above