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Date of Application		Name
Street Address		Email Address
City		State, Zip
Country
Phone Number		Social Security number
Gender	Male Female
Height		Weight
Date of Birth
This info used for  informational purposes only.
Have you had past employments with a beach service or lifeguard agency?		Yes No
If yes, name and dates of employment
Have you been employed by Lack’s/North Beach Service before?			Yes No
If yes, list dates and position
When would you be available for work?
Last date available for work?
Would you be able to work Labor Day weekend?			Yes No
Are you presently enrolled in school?			Yes No
Have you graduated High School?			Yes No
Have you graduated College?			Yes No
Have you had Military Service?	Yes No	If yes, what Branch?
Do you have a police record?	Yes No	If yes, please explain
Will you have transportation?		Yes No
Will you need housing?		Yes No
Are you legal to work in the United States? Proof of legal authorization is required  upon employment!		Yes No
Do you have current certifications of:
Lifesaving:	Yes No	What agency?
CPR for the Professional Rescuer:	Yes No	First Aid:	Yes No
Employment History
Are you currently employed?	Yes No	If yes, may we contact you employer?	Yes No
Present/Previous Employer
Dates of Employment:
Employer :
Address:
Phone number:
Type of Business:
Supervisor:		Title:
Position Held:		Start Date - End Date:
Reason for leaving:
Description of Duties:
Previous Employer
Dates of Employment:
Employer :
Address:
Phone number:
Type of Business:
Supervisor:
Position Held:
Start Date - End Date:
Reason for leaving:
Description of Duties:
Why would you be an asset to our team?
References
	Name	Phone number	Years known
1:
2:
3:
How did you hear about Lack's Beach Service?
By completing this application, I meet the requirements stated in the website by Lack’s Beach Service.  The required 500 meters swim and/or lifeguarding test are given on the applicants own time. Lack's Beach Service, Inc. and/or North Beach Service will not be liable for injury to applicants during testing.   I understand that all information provided is accurate and correct.  Any false statements will result in a withdrawal from the application process.   I give the employer the right to investigate all past employers and references for job purposes.  All information is held confidential. Pictures are welcome but not required.
Signature of Applicant: Date:
Lack's Beach Service is an equal opportunity employer.