APPLICATION FOR EMPLOYMENT

Full Name: Date of Birth:
Permanent Address: Telephone No.:
City: State: Zip : Cell Phone:
Address at School (college only): Email:
City: State: Zip : School Phone:
Social Security Number: U.S. Citizen: Yes No
In case of emergency, notify: Telephone No.:

Position desired:   Dates available:
Conflicts/Vacation Times:
Would you like to be:   Part Time Full Time

If your school year ends after memorial day, will you be available to work:
Weekends before school ends: Yes No
Weekday afternoons (4:00 pm to 8:00 pm) before school ends: Yes No
Can you work through Labor Day?    Yes No    If not when would last day be?
In the event of an SSPM staffing problem, would you be willing to fill in at another pool?    Yes No
Do you own or have access to an automobile?  Yes No    Have valid Drivers License?  Yes No
Have you ever been dismissed from employment for any reason other than lack of work Yes No

EDUCATION

 

 

NO. OF

GPA

YEAR

 

NAME

LOCATION

YEARS

 

GRAD.

HIGH SCHOOL

COLLEGE

 

 

 

 

 

 

REFERENCES

 

NAME

RELATIONSHIP

YRS KNOWN

AREA CODE

PHONE NUMBER

1.

2.

3.

TRAINING

YEAR TRAINING COURSE-

EXPIRATION DATE OF

COUNTY AND STATE WHERE LICENSE

 

WAS PASSED (mm/dd/yyyy)

LICENSE OR CERTIFICATE
(mm/dd/yyyy)

OR CERTIFICATE WAS ISSUED

 

 

 

 

RED CROSS LIFEGUARD TRAINING

YMCA LIFEGUARD TRAINING

OTHER LIFEGUARD TRAINING

CPR FOR PROFFESIONAL RESCUER

WATER SAFETY INSTRUCTOR TRAINING

OTHER RELEVANT CERTIFICATIONS

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts shall be cause for dismissal if employed.   I also understand that my employment will be summer employment only, and I will not file for unemployment when my employment ends.

Initials: Date

Previous Employment (last three positions)

EMPLOYER

DATES

DUTIES

WAGES

 PHONE

SUPERVISOR

 


PO Box 8127, West Chester, Ohio 45069
513-755-7075  fax 513-755-0640