Name *

Address: *

Phone Number: *

High School *

University, Higher Education or Trade School (if applicable)

I am applying for the following position: *

Work Experience: *

Tell us about yourself: *

List previous lifeguard, pool management or teaching (swim lessons) experience: *

Red Cross Life Saving Certificates: Check all that apply *

List the year certified and date expired for each certification that you have: *

State your work experience for the past two years: *

List 3 References (over the age of 18) other than relatives (include name, email address & phone numbers) *

What school/extracurricular activities have you participated in? *

Are you currently taking any medication or have any health concerns? If yes, please explain. *

List names, phone numbers and address of your two closest relatives in case of emergency: *

Explain in detail any previous aquatic experiences you have been removed from if any:

What days are you available to work? *

What hours are you available to work on each day checked in previous question? *

Would you be able to work weekdays and weekends until school begins in August? *

Would you be able to work weekends and after school once school begins in August until Labor Day? *