2017 EMPLOYMENT APPLICATION
Northwest Swim Club
Personal Information:
Name: ______
Address: ______
City: ______State: ______Zip: ______
Phone: ______Alternate Phone: ______
E-mail: ______
Date of Birth: ______
Position Applying For: ______
Certification Expiration Dates (if applicable):
LGI ______CPR ______WSI ______AFO/CPO ______
Education:
High School ______Location ______
Years Attended ______Date Graduated ______
College ______Location ______
Years Attended ______Date Graduated ______Degree ______
College ______Location ______
Years Attended ______Date Graduated ______Degree ______
Summarize your special skills or qualifications:
______
Work Availability:
Date Available to Start Work: ______
Probable Last Day Available to Work: ______
Vacation Dates or Other Conflicts to Your Schedule between the Above Dates: ______
Previous Employment: (most recent)
Firm ______
Phone ______
Dates of Employment ______
Position ______
Supervisor ______
Reason for Leaving ______
Firm ______
Phone ______
Dates of Employment ______
Position ______
Supervisor ______
Reason for Leaving ______
Firm ______
Phone ______
Dates of Employment ______
Position ______
Supervisor ______
Reason for Leaving ______
References:
Please furnish the names and contact information of two people to whom you are not related and by whom you have not been employed.
Name ______
Address ______
______
Phone ______
Name ______
Address ______
______
Phone ______
I certify that my answers are true and complete to the best of my knowledge.
I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools, or persons from all liability in responding to inquiries in connection with my application.
In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in my discharge.
Signature of Applicant: ______Date: ______
Signature of Parent (if under 18) ______
Return applications to:
Northwest Swim Club
Attn: Deb Juracich
PO Box 20015
Columbus, OH 43220