Name
*
First Name
Last Name
Main Phone
*
(###)
###
####
Alternate Phone
(###)
###
####
eMail Address
*
Address
*
1st Emergency Contact
*
Phone
*
(###)
###
####
2nd Emergency Contact
Phone
(###)
###
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Are you a citizen of the United States?
*
If no. do you have an Alien Registration Card?
Have you ever been charged with a crime?
*
Please list the circumstances to include the charge/offense, the date and the outcome/verdict
Do you posses a valid motor vehicle operator's license?
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License No. and State
If no, do you posses a valid state issued identification card?
Employer 1
Employer 1 Phone
(###)
###
####
Employer 1 Address
Position(s) Held, Responsibilities
Dates Employed
Supervisor's Name
First Name
Last Name
Supervisor's Phone
(###)
###
####
Employer 2
Employer 2 Phone
(###)
###
####
Employer 2 Address
Position(s) Help, Responsibilities
Dates Employed
Supervisor's Name
First Name
Last Name
Supervisor's Phone
(###)
###
####
Name and Address of School
*
Grade/Year Completed
*
List any relevant special training or certifications
To the best of your knowledge, are you currently trained, certified/licensed, qualified and capable of working as a Lifeguard in the State of Texas?
*
Are you currently certified in Lifeguarding
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Agency and Expiration Date
First Aid
*
Agency and Expiration Date
CPR
*
Agency and Expiration Date
AED
*
Agency and Expiration Date
Do you have any health issues, problems, concerns or conditions that could possibly prohibit or impede you from adequately performing your actions, duties, expectations and responsibilities as a lifeguard or interfere with your duties or employment as a lifeguard to include those that may or may not cause any kind of damage, bodily harm, death or near death to yourself, coworkers, patrons, or swimmers maintain a safe environment (including possible medication side effects?)
*
If you, please explain
Are there ANY reasons you would not be able to perform the duties of or safely function as a lifeguard?
*
If yes, please explain
How would you rate yourself as a swimmer?
*
-
Excellent
Strong
Adequate
Weak
Please list three (3) professional references
*
Please list three (3) personal references
*
Please list your available start and end dates
*
Please detail any known dates, timeframes or periods you would not be able to be scheduled for work
What are your biggest strengths? They can be a combination of physical, character, ethical, moral, qualification, etc. Sell yourself!
*
List your extracurricular activities, sports, hobbies and interests:
What are your biggest weaknesses? Please avoid phrases such as, "I'm too dedicated to work/I'm a workaholic" or "People tell me I'm too nice".
*
Any additional comments, information, questions or concerns
I certify that the statements and information contained herein are true, complete and correct to the best of my knowledge and I authorize any former employer to release to Shady Hollow Homeowners Association or to it's authorized representative any and all employment records and other information it may have about my employment. I understand that the information will be used for the purpose of evaluating my application for employment with the Association. A photocopy of this authorization shall be as valid as the original
*