On-Line Application

Date

First Name     Last Name     Middle Initial

Street Address

City     State     Zip Code

Home Phone Number     Cell Phone Number

Other Phone Number     Email Address

Social Security    Date of Birth

School Currently Attending     Grade

Years of Lifeguard Experience     Are You Currently Certified?    Yes    No

If Currently Certified, Date of Expiration for LGT     and CPR

Position Applying for:  Manager    Head Lifeguard    Lifeguard    Swim Instructor

Asking Rate of Pay $

Starting Date of Employment     Last Day of Employment

Available Hours per week to work     Do you have reliable transportation?    Yes    No

If you have experience Lifeguarding, Please provide with whom:

Employer     Pay Rate $    Dates of Employment

Employer     Pay Rate $    Dates of Employment

If you have work experience outside of lifeguarding, please provide with whom:

Employer     Pay Rate $    Dates of Employment

Employer     Pay Rate $    Dates of Employment

Note:  Aquatic Management Services offers Staff Members Referral Bonuses to our Employees.  Please complete the following section to qualify.

Referral #1     Phone Number

Referral #2     Phone Number

Referral #3     Phone Number

Referral #4     Phone Number

Personal References:  Please provide two personal references.

Reference #1     Phone Number

Reference #2     Phone Number

Emergency Contact

Name     Phone Number