Mercer Island Beach Club

Swim/Dive Coach Application

Please complete application and return to the front desk or to 8326 Avalon Drive, Mercer Island, WA 98040by March 27, 2015.

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Personal Information

Name:______Date of Birth: ______

Address: ______

Phone Number: ______Email Address: ______

Education

Name & Location / Years Attended
High School
College

Employment(Please note if you were previously employed by MIBC)

Date/Month/Year / Name of Employer / Salary / Position / Reason for Leaving / May We contact Your Employer?
From:
To: / Yes / No
From:
To: / Yes / No
From:
To: / Yes / No

References

Below, list three people not related to you, whom you have known at least one year.

Name: / Email: / Phone:

Emergency Contact

Name: ______Phone number:______Relationship______

Summer Availability

The 2015 MidlakesSwim and Dive season begins Monday, May 18th. The Swim season will run thru Sunday, July 26th when A-Champs are held. The Dive season may run thru the weekend of July 25-26th or the weekend of August 1-2. Below, in detail, please identify any conflicts you may have during the dates listed above.

Date You’re Available to Begin Coaching: ______

Known Conflict Dates/Times During the Season: ______

General(Please feel free to respond to the following questions on an additional piece of paper)

(1)If you have coached for MIBC past seasons: What are three things you did well as a coach in past seasons and what are three things you could improve upon to become a better coach?

(2)If you have never coached for MIBC: What are the three best reasons to hire you?

(3)How does the position you are applying for fit with your personal and professional goals?

(4)Are you CPR/AED/First Aid/Lifeguard certified? YES NO

  1. If yes, when do your certifications expire? ______
  2. If no, when do you intend to become certified? ______

(5)Have you ever been convicted of a crime? YES NO If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. ______

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Authorization

I authorize investigation on all statements contained in this application. I understand that misrepresentation of information requested is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without case and without previous notice.

Signature ______Date______

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