Fernwood Pool 2018 Lifeguard Application
First Name *
Your answer
Last Name *
Your answer
Home Address *
Your answer
Cell Phone / Home Phone *
Your answer
Email Address *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Social Security Number (Can be supplied later)
Your answer
Life Guard Certification (ie..Red Cross) and expiration date *
Your answer
Date Available to Start *
MM
/
DD
/
YYYY
Last Date Available to Work *
MM
/
DD
/
YYYY
Unavailable Dates *
Your answer
Last Place of employment *
Your answer
Employer Contact Information (Name & Phone #) *
Your answer
Dates Worked at this position *
Your answer
Work Performed *
Your answer
Reference 1 *
Your answer
Reference 2 *
Your answer
Refernece 3 *
Your answer
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