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Lifeguard Employment Application
Applicant
Education
Employment History
References
Certification
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Last Name
*
Phone Number
*
Phone
Tuesday
Name
ZIP
*
Height
Date you can start work
Date you must depart work to return to school
Alternate Phone Number
City
*
Weight
Wednesday
State
*
Preferred Name
Days you're available to work (Select Yes or No)
Availability
Emergency Contact
Address
Social Security Number
*
Email
*
Sunday
Applicant Details
Monday
Age
Address
*
State
First Name
*
Saturday
Thursday
City
ZIP
Date of Birth
*
Friday
Education Experience
Attach resume below in Word or PDF file format.
Enter previous education experience below.
Click "Add New Record" for each employment in descending order from Current (Last) Employer
*
Employment History
List your references, if any.
References
Submit
Type Full Name :
Sign With Hand
Clear
Done
Certification
Applicant Signature or Parent/Guardian Signature (If applicant is under 18):
*
Note:
Before you can take the lifeguard test(s) and start work:
(1) You must produce a medical doctor’s clearance certifying that you are in excellent health and that you are capable of performing the strenuous physical activities that will be required of you in taking the test(s) and in performing subsequent daily lifeguarding duties. (2) You must produce identification revealing proof of age that you are eligible for appointment (driver’s license, passport, Social Security card, etc.)
Belmar
is an AT-WILL, EQUAL OPPORTUNITY EMPLOYER and does not discriminate on the basis, of race, sex, color, religion, national origin, age, disability or veteran status in employment opportunities and benefits.
Yes
No
Yes
No
Yes
No
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CA
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KY
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MA
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MO
MT
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NM
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NC
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OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
- Territories -
AS
GU
MP
PR
UM
VI
- Armed Forces -
AA
AP
AE
Employed To
Supervisor Phone Number
Address
State
Employment History
Is this your current occupation?
Was this a lifeguarding job?
Position Held
ZIP
May We Contact this Employer?
*
Please list any major duties, other qualifications and related experiences, skills, or credentials you have. If this is a lifeguarding job, list any that are of special benefit to the job of a lifeguard, i.e CRP, AED, First-Aid, WSI, etc.):
Employed From
City
Supervisor Name
Employer Name
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AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
- Territories -
AS
GU
MP
PR
UM
VI
- Armed Forces -
AA
AP
AE
Attended From
City
State
Education Experience
Attended To
Degree Received
School Name
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Business
Personal
Reference Email
Reference Name
Reference Telephone
Reference Address
Employment Reference
Reference Relation
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Date Entered:
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