LIFEGUARD EMPLOYMENT/CERTIFICATION CLASS APPLICATION

MUST BE 15 YEARS OLD BY MAY 24, 2021 TO APPLY

APPLICATION DEADLINE IS APRIL 7, 2021

NAME * First Last
PHONE * - ### - ### ####
MESSAGE PHONE * - ### - ### ####
ADDRESS *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
EMAIL ADDRESS *
ARE YOU AT LEAST 15 YEARS OLD? *

ARE YOU AT LEAST 15 YEARS OLD? YES NO
ARE YOU OVER 18 YEARS OLD? *

ARE YOU OVER 18 YEARS OLD? YES NO
ARE YOU ELIGIBLE FOR EMPLOYMENT IN THE UNITED STATES?

ARE YOU ELIGIBLE FOR EMPLOYMENT IN THE UNITED STATES? YES NO
HAVE YOU EVER BEEN CONVICTED OF A CRIME OTHER THAN A MINOR TRAFFICE OFFENSE (INCLUDING DURING MILITARY SERVICE)?

HAVE YOU EVER BEEN CONVICTED OF A CRIME OTHER THAN A MINOR TRAFFICE OFFENSE (INCLUDING DURING MILITARY SERVICE)? YES NO
DRIVER LICENSE/PERMIT NUMBER *
SOCIAL SECURITY NUMBER
EDUCATION INFORMATION
HIGH SCHOOL NAME *
DO YOU HAVE A HIGH SCHOOL DIPLOMA/EQUIVALENT? *

DO YOU HAVE A HIGH SCHOOL DIPLOMA/EQUIVALENT? YES NO
COLLEGE/TECH SCHOOL
DO YOU HAVE A COLLEGE/TECH DEGREE?

DO YOU HAVE A COLLEGE/TECH DEGREE? YES NO
ADDITIONAL COLLEGE/TECH SCHOOL
DO YOU HAVE AN ADDITIONAL COLLEGE/TECH DEGREE?

DO YOU HAVE AN ADDITIONAL COLLEGE/TECH DEGREE? YES NO
CHOOSE ONE: *

CHOOSE ONE: CURRENTLY CERTIFIED LIFEGUARD (ENTER CERTIFICATION INFORMATION BELOW) ENROLLING IN DPR LIFEGUARD CERTIFICATION CLASS APRIL 28-MAY 1 ENROLLED IN OTHER LIFEGUARD CERTIFICATION CLASS
CERTIFICATION TITLE (LIFEGUARD AND/OR CPR)
CERTIFICATION EXPIRATION DATE
CERTIFICATION NUMBER
ADDITIONAL CERTIFICATION TITLE (LIFEGUARD AND/OR CPR)
CERTIFICATION EXPIRATION DATE
CERTIFICATION NUMBER
PREVIOUS EMPLOYMENT HISTORY
COMPANY #1
SUPERVISOR
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
BEGINNING DATE
ENDING DATE
REASON FOR LEAVING
COMPANY #2
SUPERVISOR
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
BEGINNING DATE
ENDING DATE
REASON FOR LEAVING
COMPANY #3
SUPERVISOR
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
BEGINNING DATE
ENDING DATE
REASON FOR LEAVING
A COPY OF YOUR CURRENT DRIVER LICENSE CAN BE EMAILED TO:
BROOKE@DEXTERPARK-REC.COM OR FAXED TO 573-624-5298
Draw your signature into the box below. *

Clear
City of Dexter Parks and Recreation is an equal opportunity employer, considers applicants for all positions without regard to race, color, religion, sex, age, national origin, disabled or veteran status, or other legally protected status.

I hereby certify that the facts set forth in this employment application are true and complete to the best of my knowledge. I understand that false statements of any kind or omission of facts called for on this application are a basis for dismissal regardless or when they are discovered. I understand that any employment offered is for an indefinite duration, unless otherwise specified in writing, and is at-will which means that either I or the City Of Dexter, Park Department may terminate my employment at any time with or without notice or cause. I further understand that neither the policies, rules, regulations of employment, application for employment, nor anything said during the interview process shall be deemed to constitute the terms of any implied employment contract.

LIFEGUARD EMPLOYMENT/CERTIFICATION CLASS APPLICATION

LIFEGUARD EMPLOYMENT/CERTIFICATION CLASS APPLICATION

EDUCATION INFORMATION

PREVIOUS EMPLOYMENT HISTORY

A COPY OF YOUR CURRENT DRIVER LICENSE CAN BE EMAILED TO: BROOKE@DEXTERPARK-REC.COM OR FAXED TO 573-624-5298

A COPY OF YOUR CURRENT DRIVER LICENSE CAN BE EMAILED TO:
BROOKE@DEXTERPARK-REC.COM OR FAXED TO 573-624-5298