Fayette Area Swim Team

Job Application

 

Instructions:  Please fill out all sections of this application completely.

 

Date________________________________

 

Name_________________________________________________________________

                  Last                                                 First                                         Middle

 

Address________________________________________________________________

                  Street No. or P.O. Box                     City                                                                         Zip Code

Email Address___________________________________________________________

 

Telephone Numbers_______________________________________________________

                                                                Home                                                       Cell

 

Social Security Number______ /_____ /_______ Date of Birth /_____ /_____

 

Education:  Circle Highest Grade Completed:            7   8   9   10   11   12

College:  Circle Number of Years Completed:            1  2  3  4 

Degrees Held:___________________________________________________________

Special Training/Certification

            Life Guarding ____________________________          Expiration Date_____________

            Standard First Aid_________________________          Expiration Date_____________

            CPR___________________________________          Expiration Date_____________

            Water Safety Instructor_____________________          Expiration Date_____________

 

Competitive Swimming Experience:___________________________________________

 

Previous Work Experience:  List below, beginning with most recent employment.

Employer Name & Address

 

Phone Number

 

 

 

Title/Description of Duties

 

 

 

Start/End Dates

 

Employer Name & Address

 

 

 

Phone Number

 

Title/Description of Duties

 

 

 

Start/End Dates

Employer Name & Address

 

 

 

Phone Number

 

Title/Description of Duties

 

 

 

Start/End Dates

 

 

Fayette Area Swim Team

Job Application

page 2

 

Emergency Contact___________________________________________________

                                    Name                                                                       Relationship

Address:___________________________________________________________

                                Street No. or P.O. Box                                             City                         Zip Code

 

Phone Numbers_____________________________________________________

                                                Home                                                                       Cell

 

I certify that to the best of my knowledge and belief, the information given, truly represents my background and experience.  I understand that if I have knowingly misrepresented, falsified, or omitted any of the application information, I may be disqualified for employment consideration or dismissed from employment with Fayette Area Swim Team.

 

I hereby authorize any and all school, former employers, references, courts and any others who have information about me, to provide such information to Fayette Area Swim Team, and I relieve all parties involved from  any and all liability for and any and all damage that may result from providing such information.

 

I understand that if offered a position with Fayette Area Swim Team, I may be required to submit a pre-employment medical examination, drug screen, and background check as a condition of my employment.  I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and checks will result in withdrawal of any employment offer or termination of employment, if already employed.

 

By signing below, I acknowledge that I have read, understood and agree to the above.

 

________________________________________________________________________                 ________________

Signature of Applicant                                                                                                             Date

 

________________________________________________________________________                                                             ______________________

Signature of Parent or Guardian                                                                                                Date

 

________________________________________________________________________                                                             ______________________

Signature of Parent or Guardian                                                                                                Date