Employment Rehire Application

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