Summer Application (Lifeguard)
Aquatech Management of Long Island, INC
First name *
Your answer
Middle initial
Your answer
Last name *
Your answer
Cell phone *
Use this format (555) 555-5555
Your answer
Emergency Contact *
First and Last Name
Your answer
Emergency Contact *
Relationship
Your answer
Emergency Contact Phone Number *
Use this format (555) 555-5555
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Social Security Number *
Your answer
Cell phone service provider *
Email address *
Your answer
Mailing address *
Number and Street only
Your answer
Address 2
If applicable
Your answer
Town *
Your answer
Zip Code *
Your answer
American Red Cross Lifeguard Training *
Are you certified?
Expiration Date of Certification *
Are you certified?
MM
/
DD
/
YYYY
Nassau County Pool Certification *
Are you certified?
Expiration Date of Certification
Are you certified?
MM
/
DD
/
YYYY
CPR/AED/First Aid Certification *
Expiration Date of Certification *
MM
/
DD
/
YYYY
Other certifications (WSI, etc)
Separate each by a comma
Your answer
Date you are available to start work *
MM
/
DD
/
YYYY
All Lifeguards are required to be available on Weekends/Holidays *
Will you be away for any length of time during the summer? *
Please include Dates
Your answer
EMPLOYMENT HISTORY *
Company Name:
Your answer
EMPLOYMENT HISTORY *
Supervisor:
Your answer
EMPLOYMENT HISTORY *
Supervisor Phone/Email:
Your answer
EMPLOYMENT HISTORY *
Position Title:
Your answer
Reasons For Leaving
Your answer
Salary at current or last position
Indicate /year, /day or /hr
Your answer
Work References *
Name, Title, Address, Phone Number
Your answer
Student Status *
Name of College/High School *
Your answer
When are you due back on Campus/High School? *
If hired by Aquatech, you will be asked to work until labor day. If this is not possible due to college commitments indicate when you are expected back on campus
MM
/
DD
/
YYYY
Last day available to work *
Use December 31st if you have no educational conflicts
MM
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DD
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YYYY
How did you find out about Aquatech? *
I hereby agree to give at least two weeks notice prior to leaving my position with Aquatech Management of Long Island *
Use December 31st if you have no educational conflicts
Please read before submitting
I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.
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