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Your Name *

Full Legal Name

Your Email *

Personal Email Address

Your Phone Number *

Include Area Code

Home Address *

Home Address, including City/State/Zip

Desired Wage *

Desired Wage Per Hour

Who Referred You

Employee Name, Social Media Site, Email Campaign, Signs, Other

Are you at least 18 years old? *

Yes

No

Do you have reliable transportation? *

Yes

No

Are you willing to work any shift? *

Yes

No

If no, what are your preferences?

How many hours are you interested in working a week? *

Other involvements for the Summer? *

Sports, camps, vacations, other commitments, etc.

When can you start? *

If offered employment when will you be able to start?

Reasonable Accommodations

Yes

No

Is this your first job? *

Yes

No

If no, what other job experiences have you had?

Have you graduated from High School or obtained a GED? *

Yes

No

Other Training?

Do you currently have a valid Lifeguard and CPR certification? *

Yes

No

If no, have you held a certification before?

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