Employment Application

First Name:	Middle Name:	Last Name:
Email:
Home Phone: 999-999-9999	Cell Phone: 999-999-9999
Address 1:
Address 2:
City:	State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zipcode:
Select the position(s) in which you are interested:
LG Instructor      Front Desk      Lifeguard      Head Lifeguard     Fitness Instructor     Swim Lesson Instructor
Please list relevant experience as a volunteer or participant in the position(s) indicated above. Include any classes or training specific to the area(s) of interest.
Please indicate specific certification(s) held, agency name(s) and expiration date(s).
Certification Agency Name Expiration Date Adult CPR (mm/dd/yyyy) CPR / PR (mm/dd/yyyy) First Aid (mm/dd/yyyy) AED (mm/dd/yyyy) Lifeguard Training (mm/dd/yyyy) ARC Instructor (mm/dd/yyyy) CPO (mm/dd/yyyy) ACE (mm/dd/yyyy) AFAA (mm/dd/yyyy) ACSM (mm/dd/yyyy) Other (mm/dd/yyyy)
Please indicate maximum number of hours per week you are willing to work:
Hours NOT available to work between 5 AM - 11 PM Monday - Sunday. Please note all travel time, class, meetings, etc.
Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: Sunday:
Please list three (3) references.
Name Relationship Phone Number
Attach your resume:
I certify that all the information provided by me in connection with my application, whether on this document or not, is true and complete; and I understand that any misstatement, falsification, or omission of information shall be grounds for refusal to hire or, if hired, termination. I understand that any offer of employment is contingent upon my agreement to abide by the rules and regulations of the Triangle Aquatics.
I Agree    I Disagree