Summer Application (Lifeguard)
Aquatech Management of Long Island, INC
First name *
Middle initial
Last name *
Cell phone *
Use this format (555) 555-5555
Emergency Contact *
First and Last Name
Emergency Contact *
Relationship
Emergency Contact Phone Number *
Use this format (555) 555-5555
Date of Birth *
MM
/
DD
/
YYYY
Social Security Number *
Cell phone service provider *
Email address *
Mailing address *
Number and Street only
Address 2
If applicable
Town *
Zip Code *
American Red Cross Lifeguard Training *
Are you certified?
American Red Cross Lifeguard Training *
Are you certified?
Required
Completion date of certification?
When did you finish the class?
MM
/
DD
/
YYYY
Nassau County Pool Certification *
Are you certified?
CPR/AED/First Aid Certification *
Completion date of certification? *
When did you finish the class?
MM
/
DD
/
YYYY
CPR/AED Certification *
Required
Other certifications (WSI, etc)
Separate each by a comma
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
EMPLOYMENT HISTORY *
Employer:
EMPLOYMENT HISTORY *
Address:
EMPLOYMENT HISTORY *
Supervisor:
EMPLOYMENT HISTORY *
Supervisor Phone/Email:
EMPLOYMENT HISTORY *
Position Title:
EMPLOYMENT HISTORY
Start of Employment:
MM
/
DD
/
YYYY
EMPLOYMENT HISTORY
End of Employment:
MM
/
DD
/
YYYY
Salary at current or last position
Indicate /year, /day or /hr
Reasons For Leaving
University or High School you will be attending this Fall *
Use n/a if not applicable.
Three References *
Name, Title, Address, Phone Number
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
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
/
DD
/
YYYY
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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