Morale, Welfare and Recreation Department

Application for Employment

Naval Submarine Base New London Groton, Connecticut 06349 (860) 694-3695

SPECIFIC POSITION FOR WHICH YOU ARE APPLYING: /

xxxLIFEGUARD / RECREATION AIDE

ARE YOU AVAILABLE TO WORK DAYS? / yes / NIGHTS? / yes / WEEKENDS? / yes / HOLIDAYS? / yes
YOUR NAME: / Smith / Danielle / Victoria

Last

/

First

/

Middle

/

Maiden

ADDRESS: /

573 Shewville Road

/ Ledyard / Ct / 06339

(Mailing) Number and Street

/

City

/ State / Zip code
HOME PHONE NUMBER: (860 ) / 917-5570 / PHONE NUMBER: ( 860 ) / 572-9145
YOUR SOCIAL SECURITY NUMBER: / 049808806 / YOUR DATE OF BIRTH: / 01/26/85
YOUR DRIVERS LICENSE NUMBERS/STATE OF ISSUE/EXP. DATE: /
YOUR BIRTHPLACE (City, State or Foreign Country): / New London ct
DO YOU HAVE ANY RELATIVES (Including Spouse) WORKING AT THE SUBMARINE BASE? / No-father is retired navy
NAME: / PLACE OF EMPLOYMENT: / RELATIONSHIP:
ARE YOU A U.S. CITIZEN? / yes / IF NO, EMPLOYMENT ELIGIBILITY DOCUMENT #:
ARE YOU CURRENTLY AN ACTIVE DUTY MEMBER? / no / (IF SO WE NEED A CHIT FROM YOUR COMMAND)
DEPENDANT? / FORMER ACTIVE DUTY? / RETIREE?
DATES OF FORMER ACTIVE DUTY SERVICE: / to / (MUST SUBMIT DD-214)
HAVE YOU EVER BEEN EMPLOYED BY A NONAPPROPRIATED FUND (NAF) INSTRUMENTALITY? / no
DATES/LOCATION JOB TITLE OF FORMER NAF EMPLOYMENT:
HAVE YOU EVER BEEN FIRED FROM A JOB? / no / SPECIFY:
EVER QUIT A JOB AFTER BEING NOTIFIED YOU WOULD BE FIRED? / no / SPECIFY:
HAVE YOU EVER BEEN CONVICTED FOR ANY OFFENSE? / no / SPECIFY:
(Omit minor traffic violations)
HAVE YOU EVER BEEN CONVICTED OF A FELONY? / no / SPECIFY:
YOUR HIGH SCHOOL NAME/LOCATION: / Ledyard High School/Ledyard CT / YR. GRADUATED: / 2003
YOUR COLLEGE NAME/LOCATION: / University of Connecticut / YR. GRADUATED: / 2007
DEGREES/SPECIAL TRAINING/SKILLS: / Elementary Education
MAY WE CONTACT YOUR CURRENT EMPLOYER? / yes / WHAT IS MINIMUM SALARY YOU’LL ACCEPT? / 10.00
START WITH YOUR PRESENT OR LAST JOB AND WORKING BACKWARD; LIST ALL EXPERIENCE YOU’VE HAD IN THE PAST (5) YEARS. VOLUNTEER WORK MAY BE LISTED. IF ADDITIONAL SPACE IS REQUIRED, USE A SUPPLEMENT SHEET.
COMPANY NAME: / Banana Republic / EMPLOYED FROM: / 10/06 / TO: / present
ADDRESS: / Evergreen Walk, South Windsor CT / SUPERVISOR:
PHONE: / STARTING SALARY: / 9.00 / ENDING SALARY:
WORK PERFORMED: / Sales associate, cash register, folding and maintaining store
WHY DID YOU LEAVE? / na
COMPANY NAME: / Residential Life-Uconn / EMPLOYED FROM: / August 2004 / TO: / present
ADDRESS: / Storrs CT 06269 / SUPERVISOR: / Patrick Quinn
PHONE: / 860-486-1813 / STARTING SALARY: / Free room and board +500 a month / ENDING SALARY:
WORK PERFORMED: / Responsible for 40 residents, held programs and events, answered phones, made copies, etc
WHY DID YOU LEAVE? / End of school year
COMPANY NAME: / Ledyard Park and Recreation / EMPLOYED FROM: / 6/03 / TO: / Present(summer job)
ADDRESS: / Blonders Park, Ledyard CT 06339 / SUPERVISOR: / Don Grise
PHONE: / 860-464-9112 / STARTING SALARY: / 10.25 / ENDING SALARY:
WORK PERFORMED: / Waterfront supervisor/lifeguard for highland lake and camp counselor on rainy days-trained and certified in first aid, cpr, and water safety. Was in charge of a lake with only one other non-certified life guard.
WHY DID YOU LEAVE? / End of summer
LIST NAMES/COMPLETE ADDRESSES/PHONE NUMBERS OF TWO REFERENCES NOT PREVIOUSLY LISTED ON THIS APPLICATION:
1. / Heidi Fenton/rt 12 Gales Ferry CT 06335/
2. / Jackie Gambin/Shewville Road, ledyard ct, 06339/
NOTICE TO APPLICANTS: Your application will be reviewed for qualifications a referred to the selecting official when a vacancy becomes available and qualifications are met. There is no guarantee that a position for which you are selected will have work hour requirements, which match your desires exactly. Interviews may or may not be conducted; management officials may select candidates based solely on the information provided on the application. Submission of an incomplete application will disqualify you from consideration. Falsification of information will disqualify you from consideration or may result in you termination from employment without right of appeal. The information you have provided is subject to verification and employment suitability is subject to a favorable records check by local security authorities. Your signature below constitutes an understanding of this notice.
Danielle Smith / 4/9/07
SIGNATURE / DATE