AQUATECH MANAGEMENT OF LONG ISLAND, INC.

EMPLOYMENT APPLICATION 2017

NAME______

Last First MI

ADDRESS______

Street City State Zip

HOME PHONE ( )______DATE OF BIRTH ___/___/______

CELL PHONE ( ) ______SOC.SEC. #______-______-______

Email Address ______

CURRENT CERTIFICATIONS DATE RECEIVED DATE EXPIRES

American Red Cross Lifeguard Training Yes/No ______

Nassau County Pool Certification Yes/No ______

Nassau County Bay/Beach Certification Yes/No ______

CPR Certification (DOH accepts first year only) Yes/No ______

Other Certifications (WSI, etc.) Yes/No ______

(Attach a copy of all your certifications; this application will not be processed without the proper certifications)

Days/Hours Available – All Lifeguards are required to be available on Weekends/Holidays

Monday____ Hours Available: from ______to ______

Tuesday____ Hours Available: from ______to ______

Wednesday____ Hours Available: from ______to ______

Thursday____ Hours Available: from ______to ______

Friday____ Hours Available: from ______to ______

Saturday / Sunday we require our lifeguards to be available on weekends

What date are you available to start work? ______

Will you be away for any length of time this summer? Dates? ______

______

EMPLOYMENT HISTORY:

Present Or Last Position:

Employer: ______

Address:______

Supervisor:______

Phone: ______Email:______

Position Title: ______From: ______To: ______

Responsibilities:______

______

Salary: ______

Reason for Leaving:

______

May We Contact Your Present Employer? Yes _____ No _____

Three References:

Name, Title, Address, Phone

1-______

2-______

3-______

University or High School you will be attending in the fall of 2017:

______

IF HIRED BY AQUATECH MANAGEMENT OF LONG ISLAND, INC. YOU WILL BE ASKED TO WORK UNTIL LABOR DAY. IF THIS IS NOT POSSIBLE DUE TO COLLEGE COMMITMENTS PLEASE INDICATE WHEN YOU ARE EXPECTED BACK ON CAMPUS.

*DATE YOU ARE DUE BACK ON CAMPUS ______.

*YOU WILL BE EXPECTED TO WORK UNTIL TWO DAYS BEFORE YOU ARE DUE BACK ON CAMPUS.

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Signature______

Date______