BridgeMill Athletic Club Pool Staff Application Survey

1. Position Interest

Position Interest Gate Attendant

Lifeguard

Pool Manager

Swim Lesson Instructor

Service Technician

Other

2. Please provide your Personal Information below

Please provide your Personal Information below Full Name (As it appears on your Social Security Card):
Prefer to be called by:
Email Address
Address (summer):
City:
State:
Zip:
Phone:
Cell Phone:

3. Certifications - Are you currently certified in the following?

	Yes	No
Lifeguarding	*Certifications - Are you currently certified in the following? Lifeguarding Yes	Lifeguarding No
First Aid	First Aid Yes	First Aid No
CPR - Professional Rescuer	CPR - Professional Rescuer Yes	CPR - Professional Rescuer No
Lifeguard Instructor (LGI)	Lifeguard Instructor (LGI) Yes	Lifeguard Instructor (LGI) No
Water Safety Instructor (WSI)	Water Safety Instructor (WSI) Yes	Water Safety Instructor (WSI) No

4. For each certification you answered "YES" to above, please provide the date your certification expires. Additionally, please also list any other certifications you may have.

For each certification you answered "YES" to above, please provide the date your certification expires. Additionally, please also list any other certifications you may have.

*
5. Availability

Availability What major intersection are you close to?
Do you have transportation to work? (Yes or No)
What is the date you can start work?
What will be your last day of work?

6. EDUCATION

EDUCATION Name of High School
High School Graduation Year
Name of College or University
Major
Graduation (or anticipated) Year
Clubs, Sports, Activities
Awards, Honors and Leadership Roles held

7. MOST RECENT EMPLOYMENT

MOST RECENT EMPLOYMENT Company Name:
Your Position:
Dates Worked:
Your Supervisor's Name:
Supervisor's Phone:
Your Major Job Duties:

8. SECOND MOST RECENT EMPLOYMENT

SECOND MOST RECENT EMPLOYMENT Company Name:
Your Position:
Dates Worked:
Your Supervisor's Name:
Supervisor's Phone:
Your Major Job Duties:

9. THIRD MOST RECENT EMPLOYMENT

THIRD MOST RECENT EMPLOYMENT Company Name:
Your Position:
Dates Worked:
Your Supervisor's Name:
Supervisor's Phone:
Your Major Job Duties:

*
10. REFERENCE #1

REFERENCE #1 Name:
Phone:
Years Known:

*
11. REFERENCE #2

REFERENCE #2 Name:
Phone:
Years Known:

*
12. REFERENCE #3

REFERENCE #3 Name:
Phone:
Years Known:

13. EMERGENCY NOTIFICATION

EMERGENCY NOTIFICATION Name:
Home Phone:
Work Phone:
Cell Phone:

14. I understand that my employment will be strictly summer employment, and I will not file for unemployment when my employment ends.

I understand that my employment will be strictly summer employment, and I will not file for unemployment when my employment ends. I agree with the above statement.

BridgeMill Athletic Club Pool Staff Application

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