Application for Employment "*" indicates required fields Name* First Last Permanent Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Summer Address (if different from above) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Birth Date MM slash DD slash YYYY (optional if over 18)Certifications Lifeguard Training Water Safety Instructor—WSI E.M.T. Other (check all that apply). If you are planning to get certified, please indicate the dates of your classesLifeguard Training expiration date* MM slash DD slash YYYY Where did you take the Lifeguard Training class?* WSI expiration date* MM slash DD slash YYYY Other Certifications* High School* Years Completed*Please enter a number from 0 to 4.Graduation Year* College (if applicable) Major Years CompletedPlease enter a number from 0 to 4.Graduation Year Previous Work ExperienceCompany or organization* Starting Date* MM slash DD slash YYYY Ending Date* MM slash DD slash YYYY Position or job responsibilities* Company or organization Starting Date MM slash DD slash YYYY Ending Date MM slash DD slash YYYY Position or job responsibilities ReferencesName* First Last Phone*Reference Type* Previous employer Personal Reference Teacher Other How were you referred to the Water Safety Patrol?* Current or former staff member Word of mouth Advertisement Previous exposure to Patrol Web Site Other I am available to work for the Water Safety Patrol through Labor Day weekend (1st weekend of Sept.)* Yes No, but I am available to work weekends in late August-Labor Day No, I would not be available to work after a certain date Date after which I would be unable to work* MM slash DD slash YYYY Briefly explain why you would like to work for the Water Safety Patrol*Applicant Signature* Δ
