Employment (Contact Form Signature Test) Employment Notice: JavaScript is required for this content. Name * Address * Email * Position Applying For: —Please choose an option—LifeguardPool ManagerSwim Team CoachSnack Bar AttendantSnack Bar Manager Please sign below ------------------------------------------------- Send Web Site Personal Information First Name * Middle Initial * Last Name * Address * Street Address Line 2 City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Phone Number * SSN * Email * Position Applying For: * Lifeguard Pool Manager Swim Team Coach Snack Bar Attendant Snack Bar Manager Desired Salary (per hour) * Have you had experience in the position/work you are applying for? * Yes No Please describe your experience: * When would you be available for employment (for school, etc.)? Select Date Are there any reasons that would prohibit you from working weekends, evening, etc.? * Swim team, another job, ... How many days a week do you wish to work? Days a Week 1 2 3 4 5 6 7 Days of the week that you are unable to work: * Sunday Monday Tuesday Wednesday Thursday Friday Saturday Type of Lifeguard/CPR certificate: * When received? * Where received? * Expiration: * Emergency Contact Information Please list the name and phone number of the person we should contact in case of an emergency. First Name * Last Name * Phone Number * Email * Education Status Completed College Yes No Attending College Yes No Completed High School Yes No Attending High School Yes No Year Completed References Please list up to three references. References should show the relationship to you (teacher, former employer, etc.). Do not list relatives. Reference 1: Full Name * Company * Relationship * Phone Number * Email * Reference 2: Full Name * Company * Relationship * Phone Number * Email * Reference 3: Full Name * Company * Relationship * Phone Number * Email * Please visit the Rules and Regulations page for more information. I agree to Antioch Pool's Rules and Regulations. I agree to Antioch Pool's Rules and Regulations. I authorize ARA pool employees to seek emergency medical attention. I authorize ARA pool employees to seek emergency medical attention. Electronic Signature * Please type your First and Last Name Date * I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
