Returning Staff Application

Name(Required)

First Middle Last

Nickname or Preferred Name

Date of Birth

Email(Required)

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you possess a drivers license?

From which State?

What are your dates of availability?(Required)

Education(Required)

High School/College/Other

School Name

Completed (Yes or No)

Certifications (Lifeguard, First Aid, WFA ect.)

Certification

Expiration Date

Have you ever been convicted of a criminal offense?(Required)

Yes