lifeguard application

Employee Information Section

Applicant Name
Address
City
State
Zip
Subdivision Name
Home Phone
Cell Phone
Email
High School/College attended
Are you at least 17 years old?*	Yes No
*You must provide a work permit from your school to work if you are under 17 years old

Emergency Information Section

Emergency Contact Name
Relationship
Phone

Work History Section

Are you currently a Certified American Red Cross Lifeguard?	Yes No
Date Certified
Do you have previous Life Guarding experience?	Yes No
Explain

Personal Reference Section

Name
Phone
Name
Phone

Work Reference Section

Name
Phone
Name
Phone

Referral & Comments

Who referred you to AquaMania, Inc?**
**Name of referral must be provided at time of application for referral to receive referral bonus!
Comments?