Rutland Town Pool
Lifeguard Application

Name:  _______________________________________

Address:  _____________________________________

Home Phone:  _________________Cell Phone: _________________

Email: _____________________________

Emergency Contact:  _______________________Phone: _____________

S.S.N.: _______________ D.O.B. _____  Grade entering:  ___________

Position applying for: __________________________

Are you WSI certified   y   n     or  Lifeguard certified     y   n

Is your certification in First Aid/CPR current?  y     n

Reference (1):  _________________________________
                (2):  _________________________________

Past Experience (list all):

Please list any days you cannot work between June 20th and August 25th *

As a staff person, I understand that part of my responsibilities is to accept direction from my senior staff and the head life guard.  I understand that I may not be offered the position I have applied for, and have the right to refuse that position which is offered to me.  I also understand that I am not guaranteed a position by completing this application.

Signature:______________________________Date:__________

* Tentative opening and closing dates for the Town Pool summer 2014
Rutland Town Pool
Application for Employment

Name:  _______________________________________

Address:  _____________________________________

Home Phone:  ____________________Cell Phone: __________________

Email: __________________________________

Emergency Contact:  ___________________________

Emergency Phone:  ____________________________

S.S.N.: _______________ D.O.B. _____  Grade entering:  
  
Position applying for: __________________________


Reference (1):  _________________________________
                (2):  _________________________________

Past Experience (list all):


Please list any days you cannot work between June 20th * and August 25th *


As a staff person, I understand that part of my responsibilities is to accept direction from my senior staff.  I understand that I may not be offered the position I have applied for, and have the right to refuse that position which is offered to me.  I also understand that I am not guaranteed a position by completing this application.

Signature:______________________________Date:__________

* Tentative opening and closing dates for the Town Pool summer 2014